Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
Medical Faculty, Albert-Ludwigs-University Freiburg, Freiburg, Germany.
Interact Cardiovasc Thorac Surg. 2022 May 2;34(5):872-877. doi: 10.1093/icvts/ivac020.
To evaluate the safety and efficacy of recannulating the axillary artery in reoperative proximal thoracic aortic surgery.
Between 2008 and 2020, we evaluated patients who underwent reoperative proximal thoracic aortic surgery. The patients were divided into 2 groups: (i) patients with no previous right axillary artery cannulation (primary cannulation group) and (ii) patients with a previous cannulated right axillary artery (recannulation group). We analysed the intraoperative data, cannulation-related complications, postoperative outcomes and compared the 2 groups (primary cannulation versus recannulation).
The patient (n = 132) baseline characteristics did not differ significantly between the 2 groups. There was no statistically significant difference in regard to the duration of surgery, cardiopulmonary bypass, aortic cross-clamp and antegrade cerebral perfusion time nor in regard to the total number of patients with cannulation-related complications between the 2 groups [n = 8 (8.0%) vs n = 1 (3.1%), P = 0.34]. The incidence of iatrogenic axillary artery dissection, iatrogenic aortic dissection, iatrogenic aortic dissection leading to death, axillary artery thrombosis, need for surgical repair, brachial plexus injury rates, malperfusion, high perfusion resistance and hyperperfusion syndrome revealed no significant difference between the 2 groups (P > 0.05). There were 11 (11.0%) cases of stroke in the primary cannulation group and 1 (3.1%) in the recannulation group (P = 0.18).
Recannulation of the right axillary artery in reoperative proximal thoracic aortic surgery is not associated with worse clinical outcomes and can be safely and effectively performed, also representing a preventive and rescue measure. Previous cannulation of the axillary artery should not hinder the decision for recannulation.
评估在再次行近端胸主动脉手术时重新置入股动脉的安全性和疗效。
2008 年至 2020 年，我们评估了再次行近端胸主动脉手术的患者。患者分为 2 组：（i）既往未行右腋动脉置管（初次置管组）和（ii）既往行腋动脉置管的患者（再次置管组）。我们分析了术中数据、置管相关并发症、术后结局，并比较了两组（初次置管与再次置管）。
两组患者的基线特征无显著差异。两组手术时间、体外循环时间、主动脉阻断时间和顺行性脑灌注时间无统计学差异，置管相关并发症的患者总数也无差异[n=8（8.0%）vs n=1（3.1%），P=0.34]。医源性腋动脉夹层、医源性主动脉夹层、医源性主动脉夹层导致死亡、腋动脉血栓形成、需要手术修复、臂丛神经损伤率、灌注不良、高灌注阻力和高灌注综合征的发生率在两组之间无显著差异（P>0.05）。初次置管组有 11 例（11.0%）发生脑卒中，再次置管组有 1 例（3.1%）发生脑卒中（P=0.18）。
在再次行近端胸主动脉手术时重新置入股动脉并不增加不良临床结局的风险，并且可以安全有效地进行，也可作为一种预防和抢救措施。既往腋动脉置管不应妨碍再次置管的决策。
