Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiac Surgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Ann Thorac Surg. 2024 Jun;117(6):1128-1134. doi: 10.1016/j.athoracsur.2024.02.026. Epub 2024 Mar 7.
Cannulation strategy in acute type A dissection (ATAD) varies widely without known gold standards. This study compared ATAD outcomes of axillary vs femoral artery cannulation in a large cohort from the International Registry of Acute Aortic Dissection (IRAD).
The study retrospectively reviewed 2145 patients from the IRAD Interventional Cohort (1996-2021) who underwent ATAD repair with axillary or femoral cannulation (axillary group: n = 1106 [52%]; femoral group: n = 1039 [48%]). End points included the following: early mortality; neurologic, respiratory, and renal complications; malperfusion; and tamponade. All outcomes are presented as axillary with respect to femoral.
The proportion of patients younger than 70 years in both groups was similar (n = 1577 [74%]), as were bicuspid aortic valve, Marfan syndrome, and previous dissection. Patients with femoral cannulation had slightly more aortic insufficiency (408 [55%] vs 429 [60%]; P = .058) and coronary involvement (48 [8%] vs 70 [13%]; P = .022]. Patients with axillary cannulation underwent more total aortic arch (156 [15%] vs 106 [11%]; P = .02) and valve-sparing root replacements (220 [22%] vs 112 [12%]; P < .001). More patients with femoral cannulation underwent commissural resuspension (269 [30.9%] vs 324 [35.3%]; P = .05). Valve replacement rates were not different. The mean duration of cardiopulmonary bypass was longer in the femoral group (190 [149-237] minutes vs 196 [159-247] minutes; P = .037). In-hospital mortality was similar between the axillary (n = 165 [15%]) and femoral (n = 149 [14%]) groups (P = .7). Furthermore, there were no differences in stroke, visceral ischemia, tamponade, respiratory insufficiency, coma, or spinal cord ischemia.
Axillary cannulation is associated with a more stable ATAD presentation, but it is a more extensive intervention compared with femoral cannulation. Both procedures have equivalent early mortality, stroke, tamponade, and malperfusion outcomes after statistical adjustment.
急性 A 型夹层（ATAD）的插管策略差异很大，没有明确的金标准。本研究比较了国际急性主动脉夹层注册研究（IRAD）中腋动脉与股动脉插管在大样本中的 ATAD 结果。
该研究回顾性分析了 IRAD 介入队列（1996-2021 年）中 2145 例接受腋动脉或股动脉插管的 ATAD 修复患者（腋动脉组：n=1106 [52%]；股动脉组：n=1039 [48%]）。主要终点包括早期死亡率、神经、呼吸和肾脏并发症、灌注不良和心脏压塞。所有结果均以腋动脉相对于股动脉表示。
两组中年龄小于 70 岁的患者比例相似（n=1577 [74%]），二叶式主动脉瓣、马凡综合征和既往夹层也相似。股动脉插管组的主动脉瓣关闭不全略多（408 [55%] vs 429 [60%]；P=0.058）和冠状动脉受累（48 [8%] vs 70 [13%]；P=0.022）。腋动脉插管组的全主动脉弓置换术（156 [15%] vs 106 [11%]；P=0.02）和保留瓣膜根部置换术（220 [22%] vs 112 [12%]；P<0.001）更多。股动脉插管组行瓣环重建术的患者更多（269 [30.9%] vs 324 [35.3%]；P=0.05）。瓣膜置换率无差异。股动脉组体外循环时间较长（190 [149-237] 分钟 vs 196 [159-247] 分钟；P=0.037）。腋动脉组（n=165 [15%]）和股动脉组（n=149 [14%]）住院死亡率相似（P=0.7）。此外，两组在卒中、内脏缺血、心脏压塞、呼吸功能不全、昏迷或脊髓缺血方面均无差异。
腋动脉插管与更稳定的 ATAD 表现相关，但与股动脉插管相比，它是一种更广泛的干预措施。经统计学调整后，两种手术方法的早期死亡率、卒中和心脏压塞以及灌注不良的结果相当。
