累及右腋动脉的急性 A 型主动脉夹层行右腋动脉插管。
Right axillary artery cannulation in acute type A aortic dissection with involvement of the right axillary artery.
机构信息
Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; School of Medicine, Jishou University, Jishou, China.
出版信息
J Thorac Cardiovasc Surg. 2024 Jul;168(1):50-59.e6. doi: 10.1016/j.jtcvs.2022.09.058. Epub 2022 Oct 14.
OBJECTIVE
The right axillary artery is currently recommended for arterial cannulation in surgery for acute type A aortic dissection. However, the feasibility of cannulation on a dissected right axillary artery remains undetermined. The objective was to examine the feasibility of cannulation on a dissected right axillary artery.
METHODS
From 2016 to 2020, 835 patients who underwent acute type A aortic dissection repair were included in this study. Cannulation strategy and perioperative outcomes of patients who did and did not have right axillary artery dissection were compared. Propensity score matching and logistic regression were applied.
RESULTS
A total of 124 patients had right axillary artery dissection, and 711 patients did not. Direct right axillary artery cannulation was used for cardiopulmonary bypass in the majority of patients, but with a lower rate in patients with right axillary artery dissection (n = 88 [71.0%] vs n = 579 [81.4%], P = .007). Right axillary artery cannulation failure (n = 3 [2.4%] vs n = 5 [0.7%], P = .102) and related complications (n = 1 [0.8%] vs n = 6 [0.8%], P = 1.000) were rare in both groups. In-hospital mortality (n = 18 [14.5%] vs n = 59 [8.3%], P = .027) and stroke (n = 14 [11.3%] vs n = 42 [5.9%], P = .027) were significantly higher in the right axillary artery dissection group, but after propensity score matching, in-hospital outcomes were comparable. Right axillary artery dissection was not a risk factor for mortality, stroke, right axillary artery cannulation not performed, or right axillary artery cannulation failure.
CONCLUSIONS
Direct right axillary artery cannulation is feasible for most patients with acute type A aortic dissection with right axillary artery dissection.
目的
目前建议在急性 A 型主动脉夹层手术中经腋动脉右侧进行动脉插管。然而，在夹层腋动脉上进行插管的可行性仍未确定。本研究旨在探讨在夹层腋动脉上进行插管的可行性。
方法
2016 年至 2020 年，共纳入 835 例急性 A 型主动脉夹层患者。比较了有和无右腋动脉夹层患者的插管策略和围手术期结局。采用倾向评分匹配和 logistic 回归分析。
结果
共有 124 例患者存在右腋动脉夹层，711 例患者无右腋动脉夹层。大多数患者采用直接右腋动脉插管进行体外循环，但右腋动脉夹层患者的插管率较低（n=88[71.0%] vs n=579[81.4%]，P=0.007）。右腋动脉插管失败（n=3[2.4%] vs n=5[0.7%]，P=0.102）和相关并发症（n=1[0.8%] vs n=6[0.8%]，P=1.000）在两组中均很少见。院内死亡率（n=18[14.5%] vs n=59[8.3%]，P=0.027）和卒中（n=14[11.3%] vs n=42[5.9%]，P=0.027）在右腋动脉夹层组明显较高，但经倾向评分匹配后，院内结局相当。右腋动脉夹层不是死亡、卒中、未进行右腋动脉插管或右腋动脉插管失败的危险因素。
结论
对于大多数伴有右腋动脉夹层的急性 A 型主动脉夹层患者，直接右腋动脉插管是可行的。
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