Lemaire Anthony, Levine Dov, Chao Joshua, Sabatino Marlena E, Ikegami Hirohisa, Takebe Manabu, Russo Mark J, Lee Leonard Y
Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
J Thorac Dis. 2023 Mar 31;15(3):1057-1062. doi: 10.21037/jtd-22-576. Epub 2023 Feb 27.
Establishing cardiopulmonary bypass remains critical to the successful repair of an acute type A aortic dissection. A recent trend away from femoral arterial cannulation has occurred in part due to concerns of stroke risk from retrograde perfusion to the brain. The purpose of this study was to determine if arterial cannulation site for aortic dissection repair impacts surgical outcomes.
A retrospective chart review was performed at Rutgers Robert Wood Johnson Medical School from January 1st, 2011 to March 8th, 2021. Of the 135 patients included, 98 (73%) underwent femoral arterial cannulation, 21 (16%) axillary artery cannulation, and 16 (12%) direct aorta cannulation. The study variables included demographic data, cannulation site, and complications.
The mean age was 63.6±14 years, with no difference between the femoral, axillary, and direct cannulation groups. Eighty-four patients (62%) were male, with similar percentages amongst each group. The rates of bleeding, stroke, and mortality specifically due to the arterial cannulation did not significantly differ based on cannulation site. None of the patients had strokes that were attributable to cannulation type. No patients died as a direct complication of arterial access. The overall in-hospital mortality was 22%, similar between groups.
This study found no statistically significant different in rates of stroke or other complications based on cannulation site. Femoral arterial cannulation thus remains a safe and efficient choice for arterial cannulation in the repair of acute type A aortic dissection.
建立体外循环对于急性A型主动脉夹层的成功修复仍然至关重要。最近，部分由于担心逆行灌注至脑部会带来中风风险，出现了一种减少股动脉插管的趋势。本研究的目的是确定主动脉夹层修复的动脉插管部位是否会影响手术结果。
于2011年1月1日至2021年3月8日在罗格斯罗伯特伍德约翰逊医学院进行了一项回顾性病历审查。纳入的135例患者中，98例（73%）接受了股动脉插管，21例（16%）接受了腋动脉插管，16例（12%）接受了直接主动脉插管。研究变量包括人口统计学数据、插管部位和并发症。
平均年龄为63.6±14岁，股动脉、腋动脉和直接插管组之间无差异。84例患者（62%）为男性，各组之间的百分比相似。因动脉插管导致的出血、中风和死亡率在插管部位之间没有显著差异。没有患者的中风可归因于插管类型。没有患者因动脉穿刺的直接并发症死亡。总体住院死亡率为22%，各组之间相似。
本研究发现，基于插管部位的中风发生率或其他并发症在统计学上没有显著差异。因此，股动脉插管仍然是急性A型主动脉夹层修复中动脉插管的一种安全有效的选择。
