Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey.
BMC Cardiovasc Disord. 2024 Aug 28;24(1):462. doi: 10.1186/s12872-024-04125-1.
Aortic arch disease is a major cause of acute dissections. Surgical replacement is the current curative treatment for aortic arch disease. While traditional aortic cannulation ensures lower body perfusion, axillary cannulation offers optimum cerebral perfusion.
To evaluate the outcomes of aortic and axillary cannulation methods in hemiarch replacements, focusing on postoperative perfusion and survival.
A retrospective analysis was conducted on 91 patients who underwent hemiarch replacement surgery between February 2007 and October 2016. Patients were divided into two groups based on the cannulation method: aortic cannulation (54 patients) and axillary cannulation (37 patients). Data regarding preoperative, intraoperative, and postoperative parameters were analyzed, including demographics, surgical outcomes, and complications.
Demographic analysis showed comparable characteristics between the two groups, with notable differences in aortic disease severity and classification. Patients in the axillary group had a larger ascending aorta diameter (57.7 ± 10.8 mm vs. 51.8 ± 5.7 mm, p = 0.002) and a higher prevalence of acute dissections (27.0% (n = 10) vs. 3.7% (n = 2), p = 0.001). Cerebral protection methods varied significantly between the two groups (p < 0.001). Antegrade cerebral perfusion was used in 37.8% (n = 14) of the axillary group compared to 3.7% (n = 2) of the central group. The central cannulation group had a higher proportion of patients with temperatures under 20 °C (98.1% (n = 53) vs. 21.6% (n = 8), p < 0.001), whereas the axillary group maintained higher temperatures (24 -28 °C) in 68.6% (n = 23) of cases. AV repair/replacement was more frequent in the aortic cannulation group (48.2% (n = 26) vs. 18.9% (n = 7), p = 0.013). No significant disparities were observed in operative mortality or intraoperative complications. Statistical analysis showed no significant differences between the two groups in the in-hospital outcomes, but renal complications were more prevalent in the axillary cannulation group with 21.6% (n = 8) experiencing acute kidney injury compared to 9.3% (n = 5) in the central group (p = 0.098). The overall survival rate was slightly higher in the aortic cannulation group at various follow-up periods, yet no statistically significant difference was found between the two groups.
We found no significant differences in safety and efficacy between axillary cannulation and aortic cannulation in hemiarch replacement procedures.
主动脉弓疾病是急性夹层的主要原因。手术置换是目前治疗主动脉弓疾病的方法。虽然传统的主动脉插管可确保下半身灌注，但腋动脉插管可提供最佳的脑灌注。
评估在半弓置换术中使用主动脉和腋动脉插管方法的结果，重点关注术后灌注和生存。
对 2007 年 2 月至 2016 年 10 月期间接受半弓置换手术的 91 例患者进行回顾性分析。根据插管方法将患者分为两组：主动脉插管（54 例）和腋动脉插管（37 例）。分析了术前、术中及术后参数的数据，包括人口统计学、手术结果和并发症。
两组患者的人口统计学分析显示出相似的特征，但主动脉疾病的严重程度和分类存在显著差异。腋动脉组患者的升主动脉直径更大（57.7±10.8mm 比 51.8±5.7mm，p=0.002），急性夹层的发生率更高（27.0%（n=10）比 3.7%（n=2），p=0.001）。两组之间的脑保护方法存在显著差异（p<0.001）。腋动脉组中有 37.8%（n=14）的患者采用顺行性脑灌注，而中央组只有 3.7%（n=2）的患者采用该方法。中央插管组中体温低于 20°C 的患者比例更高（98.1%（n=53）比 21.6%（n=8），p<0.001），而腋动脉组中有 68.6%（n=23）的患者保持在 24-28°C 的较高温度。主动脉插管组中进行房室修复/置换的患者更为常见（48.2%（n=26）比 18.9%（n=7），p=0.013）。两组的手术死亡率或术中并发症无显著差异。统计分析显示，两组患者的住院期间结果无显著差异，但腋动脉插管组的肾并发症更为常见，有 21.6%（n=8）的患者发生急性肾损伤，而中央组只有 9.3%（n=5）的患者发生该并发症（p=0.098）。在不同的随访期间，主动脉插管组的总生存率略高，但两组之间无统计学差异。
我们发现，在半弓置换术中，腋动脉插管和主动脉插管在安全性和疗效方面没有显著差异。
