Tong Guang, Zhuang Dong-Lin, Sun Zhong-Chan, Chen Ze-Rui, Fan Rui-Xin, Sun Tu-Cheng
Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Shantou University Medical College, Shantou, China.
J Thorac Dis. 2021 Feb;13(2):671-680. doi: 10.21037/jtd-20-2113.
To evaluate the safety and efficacy of femoral artery cannulation as an alternative to axillary artery cannulation, we retrospectively compared outcomes between patients with axillary or femoral artery cannulation during open aortic arch repair for type A aortic dissection (TAAD).
Between January 2014 and January 2019, 646 patients underwent open aortic arch repair with circulatory arrest for TAAD using antegrade selective cerebral perfusion (SACP) and were divided into two groups according to the site of arterial cannulation: an axillary artery group (axillary group, n=558) or a femoral artery group (femoral group, n=88). The axillary artery was considered as the primary cannulation site, and the femoral artery was used as an alternative when axillary artery cannulation was deemed unsuitable or had failed. Propensity score matching was performed to correct baseline differences.
After propensity score matching, the patients' characteristics were comparable between groups (n=85 in each). The incidence of in-hospital mortality (10.6% 14.1%; P=0.642) and stroke (3.5% 5.9%; P=0.720) were comparable between the axillary and femoral groups. The incidence of newly required dialysis was lower in the femoral group, but the difference was not statistically significant (34.1% 20.0%; P=0.050). Other outcomes and major adverse events were comparable.
Femoral artery cannulation produced similar perioperative outcomes to axillary cannulation after open arch repair for TAAD. The femoral artery can be used as a safe and effective alternative to the axillary artery for arterial cannulation in TAAD patients undergoing open arch repair.
为评估股动脉插管作为腋动脉插管替代方法的安全性和有效性，我们回顾性比较了在A型主动脉夹层（TAAD）开放主动脉弓修复术中采用腋动脉或股动脉插管患者的预后。
在2014年1月至2019年1月期间，646例患者接受了TAAD开放主动脉弓修复术并在循环停搏下采用顺行选择性脑灌注（SACP），根据动脉插管部位分为两组：腋动脉组（腋动脉组，n = 558）或股动脉组（股动脉组，n = 88）。腋动脉被视为主要插管部位，当腋动脉插管被认为不合适或失败时，股动脉用作替代。进行倾向评分匹配以校正基线差异。
倾向评分匹配后，两组患者的特征具有可比性（每组n = 85）。腋动脉组和股动脉组的住院死亡率（10.6%对14.1%；P = 0.642）和卒中发生率（3.5%对5.9%；P = 0.720）具有可比性。股动脉组新需要透析的发生率较低，但差异无统计学意义（34.1%对20.0%；P = 0.050）。其他预后和主要不良事件具有可比性。
在TAAD开放主动脉弓修复术后，股动脉插管产生的围手术期结果与腋动脉插管相似。对于接受开放主动脉弓修复术的TAAD患者，股动脉可作为腋动脉安全有效的动脉插管替代方法。
