Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Thorac Cardiovasc Surg. 2020 Mar;159(3):772-778.e4. doi: 10.1016/j.jtcvs.2019.02.112. Epub 2019 Mar 15.
To evaluate the efficacy of axillary artery cannulation for early embolic stroke and operative mortality, we retrospectively compared the outcomes between patients with or without axillary artery cannulation during open aortic arch repair with circulatory arrest.
Between January 2004 and December 2017, 468 patients underwent open aortic arch repair with circulatory arrest using antegrade cerebral perfusion and were divided into 2 groups according to the site of arterial cannulation: the axillary artery (axillary group, n = 352) or another site (nonaxillary group, n = 116) groups. Embolic stroke was defined as a physician-diagnosed new postoperative neurologic deficit lasting more than 72 hours, generally confirmed by computed tomography or magnetic resonance imaging.
After propensity score matching, the patients' characteristics were comparable between the groups (n = 116 in each). The incidences of acute type A dissection, aortic rupture, shock, or emergency operation were similar between groups. The incidence of early embolic stroke was significantly lower in axillary group (n = 3 [2.6%] vs n = 10 [8.6%]; P = .046). Also, 30-day mortality (n = 3 [2.6%] vs n = 10 [8.6%]; P = .046) and in-hospital mortality (n = 3 [2.6%] vs n = 11 [9.5%]; P = .027) occurred significantly lower in the axillary group.
Axillary artery cannulation reduced the early embolic stroke and early mortality after open arch repair with circulatory arrest. Axillary artery cannulation as the arterial cannulation site during open arch repair with circulatory arrest may be helpful in preventing embolic stroke and reducing early mortality.
为了评估腋动脉插管在早期栓塞性卒中及手术死亡率方面的疗效，我们回顾性比较了在体外循环下升主动脉手术修复期间接受或未接受腋动脉插管患者的结局。
2004 年 1 月至 2017 年 12 月，468 例行体外循环下顺行性脑灌注升主动脉手术修复的患者，根据动脉插管部位分为腋动脉（腋动脉组，n=352）或其他部位（非腋动脉组，n=116）。栓塞性卒中定义为术后持续超过 72 小时的新的由医生诊断的神经功能缺损，通常通过计算机断层扫描或磁共振成像来确认。
经过倾向评分匹配后，两组患者的特征具有可比性（每组 n=116）。两组急性 A 型夹层、主动脉破裂、休克或急诊手术的发生率相似。腋动脉组的早期栓塞性卒中发生率显著较低（n=3[2.6%] vs n=10[8.6%]；P=0.046）。同样，腋动脉组 30 天死亡率（n=3[2.6%] vs n=10[8.6%]；P=0.046）和住院死亡率（n=3[2.6%] vs n=11[9.5%]；P=0.027）也显著较低。
腋动脉插管可降低体外循环下升主动脉修复术后早期栓塞性卒中及早期死亡率。腋动脉插管作为体外循环下升主动脉手术修复的动脉插管部位可能有助于预防栓塞性卒中并降低早期死亡率。
