Penov Kiril, Kohnle Patrick, Haugen Matz Andreas, Radakovic Dejan, Madrahimov Nodir, Machwart Khaled, Hamouda Khaled, Leyh Rainer, Bening Constanze
Department of Thoracic and Cardiovascular Surgery, University Hospital Wurzburg, Würzburg, Germany.
Independent Researcher, Oslo, Norway.
J Thorac Dis. 2024 Dec 31;16(12):8173-8183. doi: 10.21037/jtd-24-735. Epub 2024 Dec 28.
The selection of the cannulation site for elective aortic surgery is mostly an individual choice based on the surgeon's experience and the surgical strategy. We evaluated the long-term outcomes of right common carotid artery (CCA) cannulation using a side graft to establish unilateral selective antegrade cerebral perfusion (uSACP).
We reviewed the records of 343 patients who underwent elective ascending aortic or aortic arch surgery between 2013 and 2020. One hundred aortic procedures were performed using the right CCA as the sole arterial cannulation site under moderate hypothermic circulatory arrest (MHCA). Cross-validated least absolute shrinkage and selection operator (LASSO) and stepwise Cox regression were applied to model the effects of cannulation sites on adverse outcomes. Kaplan-Meier analysis compared mortality in the treatment group with that in the general population.
The mean patient age was 65.9±9.5 years (81% male). The mean MHCA temperature was 27.1±5.1 ℃, and the average uSACP duration was 13.6±7.7 minutes. The early mortality and stroke rates were 1% and 4%, respectively. After a median of 5.4 follow-up years, seven patients suffered stroke, with 92% survival at 6 years, similar to an age- and gender-matched general population (log-rank P=0.50). Multivariable analysis revealed that age at surgery was the only significant predictor of late stroke or death [hazard ratio (HR) =1.083; P=0.01; c-index 0.683). Control Doppler ultrasound examination after a median of 2.3 years found no evidence of injury or dissection of the right CCA.
Cannulation of the right carotid artery is a safe, feasible, and practical adjunct technique for proximal aortic surgery that generates comparable short- and long-term results. Careful patient selection and techniques are essential to minimize risk.
择期主动脉手术插管部位的选择主要基于外科医生的经验和手术策略的个人选择。我们评估了使用侧支移植物建立单侧选择性顺行性脑灌注（uSACP）的右颈总动脉（CCA）插管的长期结果。
我们回顾了2013年至2020年间接受择期升主动脉或主动脉弓手术的343例患者的记录。在中度低温循环骤停（MHCA）下，以右CCA作为唯一动脉插管部位进行了100例主动脉手术。应用交叉验证的最小绝对收缩和选择算子（LASSO）和逐步Cox回归来模拟插管部位对不良结局的影响。Kaplan-Meier分析比较了治疗组与一般人群的死亡率。
患者平均年龄为65.9±9.5岁（男性占81%）。平均MHCA温度为27.1±5.1℃，平均uSACP持续时间为13.6±7.7分钟。早期死亡率和中风率分别为1%和4%。中位随访5.4年后，7例患者发生中风，6年生存率为92%，与年龄和性别匹配的一般人群相似（对数秩检验P=0.50）。多变量分析显示，手术年龄是晚期中风或死亡的唯一显著预测因素[风险比（HR）=1.083；P=0.01；c指数0.683]。中位2.3年后的对照多普勒超声检查未发现右CCA损伤或夹层的证据。
右颈动脉插管是近端主动脉手术一种安全、可行且实用的辅助技术，可产生相当的短期和长期结果。仔细的患者选择和技术对于将风险降至最低至关重要。
