Gokalp Orhan, Yilik Levent, Iner Hasan, Yesilkaya Nihan Karakas, Besir Yuksel, Iscan Sahin, Eygi Bortecin, Gurbuz Ali
Izmir Katip Celebi University Faculty of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery, Izmir Katip Celebi University, Faculty of Medicine, Izmir, Turkey.
Izmir Katip Celebi University Ataturk Education and Research Hospital Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery, Izmir Katip Celebi University, Ataturk Education and Research Hospital, Izmir, Turkey.
Braz J Cardiovasc Surg. 2020 Feb 1;35(1):28-33. doi: 10.21470/1678-9741-2018-0354.
One of the most important points of the acute type A aortic dissection surgery is how to perform cannulation regarding cerebral protection concerns and the conditions of arterial structures as a pathophysiological consequence of the disease.
In this study, femoral and axillary cannulation methods were compared in acute type A aortic dissection operations.
The study retrospectively evaluated 52 patients who underwent emergency surgery for acute type A aortic dissection. Patients without malperfusion according to Penn Aa classification were chosen for preoperative standardization of the study groups. The femoral arterial cannulation group was group 1 (n=22) and the axillary arterial cannulation group was group 2 (n=30). The groups were compared in terms of perioperative and postoperative results.
There was no statistically significant difference in terms of preoperative data. In terms of postoperative parameters, especially early mortality and new-onset cerebrovascular event, there was no statistically significant difference. Mortality rates in group 1 and group 2 were 13.6% (n=3) and 10% (n=3), respectively (P=0.685). Postoperative new-onset cerebral events ratio was found in 5 (22.7%) in the femoral cannulation group and 6 (20%) in the axillary cannulation group (P=0.812).
Both femoral and axillary arterial cannulation methods can be safely performed in patients with acute type A aortic dissection, provided that cerebral protection strategies should be considered in the first place. The method to be performed may vary depending on the patient's current medical condition or the surgeon's preference.
急性A型主动脉夹层手术最重要的要点之一是，鉴于脑保护问题以及作为该疾病病理生理后果的动脉结构状况，如何进行插管。
本研究比较了急性A型主动脉夹层手术中股动脉和腋动脉插管方法。
本研究回顾性评估了52例行急性A型主动脉夹层急诊手术的患者。根据Penn Aa分类法，选择无灌注不良的患者进行研究组术前标准化。股动脉插管组为第1组（n = 22），腋动脉插管组为第2组（n = 30）。比较两组围手术期和术后结果。
术前数据方面无统计学显著差异。在术后参数方面，尤其是早期死亡率和新发脑血管事件，无统计学显著差异。第1组和第2组的死亡率分别为13.6%（n = 3）和10%（n = 3）（P = 0.685）。股动脉插管组术后新发脑事件发生率为5例（22.7%），腋动脉插管组为6例（20%）（P = 0.812）。
对于急性A型主动脉夹层患者，股动脉和腋动脉插管方法均可安全实施，但首先应考虑脑保护策略。具体实施方法可能因患者当前病情或外科医生的偏好而异。
