Yoon Tae-Hong, Lee Han Sol, Jang Jae Seok, Cho Jun Woo, Lee Chul Ho
Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Korea.
J Chest Surg. 2024 Jul 5;57(4):380-386. doi: 10.5090/jcs.23.156. Epub 2024 Apr 23.
Type A aortic dissection (AD) and intramural hematoma (IMH) are critical medical conditions. Emergency surgery is typically performed under cardiopulmonary bypass immediately after diagnosis, which involves lowering the body temperature to induce total circulatory arrest. Selection of the arterial cannulation site is a critical consideration in cardiac surgery and becomes more challenging in patients with AD. This study explored the strengths and weaknesses of different cannulation methods by comparing each cannulation strategy and analyzing the reasons for patients' outcomes, especially mortality and cerebrovascular accidents (CVAs).
This retrospective study reviewed the medical records of patients who underwent surgery for type A AD or IMH between 2008 and 2023, using the moderate hypothermic circulatory arrest approach at a single center.
Among the 146 patients reviewed, 32 underwent antegrade cannulation via axillary, innominate artery, aortic, or transapical cannulation, while 114 underwent retrograde cannulation via the femoral artery. The analysis of surgical outcomes revealed a significant difference in the total surgical time, with 356 minutes for antegrade and 443 minutes for retrograde cannulation (p<0.001). The mean length of stay in the intensive care unit was significantly longer in the retrograde group (5±16 days) than in the antegrade group (3±5 days, p=0.013). Nevertheless, no significant difference was found between the groups in the 30-day mortality or postoperative CVA rates (p=0.2 and p=0.7, respectively).
Surgeons should consider an appropriate cannulation strategy for each patient instead of adhering strictly to a specific approach in AD surgery.
A型主动脉夹层（AD）和壁内血肿（IMH）是严重的病症。诊断后通常立即在体外循环下进行急诊手术，这需要降低体温以诱导全循环停止。动脉插管部位的选择是心脏手术中的关键考虑因素，在AD患者中更具挑战性。本研究通过比较每种插管策略并分析患者预后的原因，特别是死亡率和脑血管意外（CVA），探讨了不同插管方法的优缺点。
这项回顾性研究回顾了2008年至2023年间在单一中心采用中度低温循环停止方法接受A型AD或IMH手术的患者的病历。
在146例接受回顾的患者中，32例通过腋动脉、无名动脉、主动脉或经心尖插管进行顺行插管，而114例通过股动脉进行逆行插管。手术结果分析显示，总手术时间存在显著差异，顺行插管为356分钟，逆行插管为443分钟（p<0.001）。逆行组在重症监护病房的平均住院时间（5±16天）明显长于顺行组（3±5天，p=0.013）。然而，两组在30天死亡率或术后CVA发生率方面没有显著差异（分别为p=0.2和p=0.7）。
在AD手术中，外科医生应针对每位患者考虑合适的插管策略，而不是严格遵循特定方法。
