Talwar Arpit, Wiadji Elvina, Mathur Manu N
Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.
Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, North Shore Private Hospital, Sydney, NSW, Australia.
Heart Lung Circ. 2019 Feb;28(2):342-347. doi: 10.1016/j.hlc.2018.03.019. Epub 2018 Mar 29.
The optimal arterial cannulation site in patients undergoing surgical management of acute type A aortic dissection (ATAAD) remains controversial. The axillary artery is rarely involved in the dissection process, provides antegrade flow in the descending aorta and minimises intraoperative malperfusion. The purpose of this study is to evaluate a single surgeon's experience of axillary artery cannulation for ATAAD repair.
All consecutive patients over a 15-year period having surgical repair of ATAAD were included in this study.
There were 55 patients with a mean age of 67years. The most common risk factors were hypertension (83.6%), connective tissue disease (7.3%) and a bicuspid aortic valve (7.3%). Axillary artery cannulation was performed on 50 patients (90.9%) and was contraindicated in the remaining five patients. Forty-nine patients survived to 30days with a 10.9% 30-day mortality rate. There was one confirmed stroke (1.8%) and no new malperfusion noted postoperatively. There were no major axillary artery complications or new dissection related to cannulation. We attribute these results, which are lower than those reported in the International Registry of Acute Aortic Dissection (IRAD) database, to axillary artery cannulation providing antegrade flow in the descending aorta from the outset and reducing intraoperative malperfusion. We believe this technique offers a cerebroprotective advantage and also facilitates selective antegrade cerebral perfusion (SACP) when aortic arch replacement is required.
We believe the axillary artery is the ideal cannulation site of ATAAD and helps to reduce mortality and neurological complications in this high-risk group of patients.
在接受急性A型主动脉夹层（ATAAD）手术治疗的患者中，最佳动脉插管部位仍存在争议。腋动脉很少参与夹层过程，可在降主动脉提供顺行血流，并使术中灌注不良最小化。本研究的目的是评估一位外科医生对ATAAD修复进行腋动脉插管的经验。
本研究纳入了15年间所有连续接受ATAAD手术修复的患者。
共有55例患者，平均年龄67岁。最常见的危险因素是高血压（83.6%）、结缔组织病（7.3%）和二叶式主动脉瓣（7.3%）。50例患者（90.9%）进行了腋动脉插管，其余5例患者禁忌插管。49例患者存活至30天，30天死亡率为10.9%。有1例确诊中风（1.8%），术后未发现新的灌注不良。没有与插管相关的重大腋动脉并发症或新的夹层。我们将这些低于国际急性主动脉夹层注册（IRAD）数据库报告结果的结果归因于腋动脉插管从一开始就在降主动脉提供顺行血流并减少术中灌注不良。我们认为该技术具有脑保护优势，并且在需要进行主动脉弓置换时也便于进行选择性顺行脑灌注（SACP）。
我们认为腋动脉是ATAAD的理想插管部位，有助于降低这一高危患者群体的死亡率和神经并发症。
