Xie Yi, Liu Yu, Yang Peng, Lu Chen, Hu Jia
Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Cardiovascular Surgery, West China Guang'an Hospital, Sichuan University, Guang'an, China.
Front Cardiovasc Med. 2022 Jun 10;9:925709. doi: 10.3389/fcvm.2022.925709. eCollection 2022.
There is a growing perception of using axillary artery cannulation to improve operative outcomes in cardiopulmonary bypass surgery. Two techniques, direct cannulation or side-graft cannulation, can be used for axillary artery cannulation, but which technique is better is controversial.
A meta-analysis of comparative studies reporting operative outcomes using direct cannulation vs. side-graft cannulation was performed. We searched the PubMed, EMbase, Web of Science, and Cochrane Library. Outcomes of interest were neurological dysfunction, cannulation-related complications and early mortality. The fixed effects model was used.
A total of 1,543 patients were included in the final analysis. Direct cannulation was used in 846 patients, and side-graft cannulation was used in 697 patients. Meta-analysis showed a higher occurrence of neurological Complication in direct cannulation group [odds ratio, 1.45, 95% CI (1.00, 2.10), χ = 4.40, = 0.05] and a significantly higher incidence of cannulation-related complications in the direct cannulation group [odds ratio, 3.12, 95% CI (1.87, 5.18), χ = 2.54, < 0.0001]. The incidence of early mortality did not have a difference [odds ratio, 0.95, 95% CI (0.64, 1.41), χ = 6.35, = 0.79].
This study suggests that side-graft axillary artery cannulation is a better strategy as it reduces the incidence of neurological dysfunction and cannulation-related complications.
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022325456.
人们越来越认识到在体外循环手术中使用腋动脉插管来改善手术结果。腋动脉插管可采用两种技术，即直接插管或侧支移植插管，但哪种技术更好存在争议。
对比较直接插管与侧支移植插管手术结果的研究进行荟萃分析。我们检索了PubMed、EMbase、科学网和考克兰图书馆。感兴趣的结果是神经功能障碍、插管相关并发症和早期死亡率。采用固定效应模型。
最终分析共纳入1543例患者。846例患者采用直接插管，697例患者采用侧支移植插管。荟萃分析显示，直接插管组神经并发症发生率更高[优势比，1.45，95%置信区间(1.00, 2.10)，χ = 4.40，P = 0.05]，直接插管组插管相关并发症发生率显著更高[优势比，3.12，95%置信区间(1.87, 5.18)，χ = 2.54，P < 0.0001]。早期死亡率发生率无差异[优势比，0.95，95%置信区间(0.64, 1.41)，χ = 6.35，P = 0.79]。
本研究表明，侧支移植腋动脉插管是一种更好的策略，因为它可降低神经功能障碍和插管相关并发症的发生率。
