Nunez-Ordonez Nicolas, Senociain Julian, Umaña Juan Pablo, Amado-Olivares Andres Felipe, Villa Carlos Andrés, Obando Carlos, Camacho Jaime
Cardiovascular Surgery Department, Fundacion Cardioinfantil-LaCardio, Bogotá, Colombia.
Cardiovascular Surgery Resident, Faculty of Medicine, Universidad del Rosario, Bogotá, Colombia.
Aorta (Stamford). 2024 Aug;12(4):80-85. doi: 10.1055/s-0045-1802993. Epub 2025 Feb 17.
Type A aortic dissection as a highly lethal disease continues being a great challenge for cardiac surgeons worldwide. There are still unanswered questions regarding intraoperative decisions and their impact on the surgical outcomes. The aim of this study is to compare postoperative outcomes according to site of cannulation in patients with acute Type A aortic dissection (ATAAD).This was a retrospective cohort study. We included all ATAAD procedures from January 2002 to November 2023. We defined groups according to site of cannulation (aorta, axillary, femoral, innominate). Data from pre-, intra-, and postoperative variables were collected. Our main outcomes were spinal cord injury (SCI), stroke rate, and in-hospital mortality. Between-group comparisons were performed using standard statistical tests and post hoc tests adjusting for multiple comparisons were performed.We identified 127 ATAAD procedures. Reoperation for bleeding was significantly higher in the femoral cannulation group (75%, = 0.0006). There were no statistically significant differences in acute kidney injury rate ( = 0.012), SCI rate ( = 0.78), or in-hospital mortality ( = 0.75). Our data suggest that there is a lower stroke rate in the axillary cannulation group (3.6%, = 0.4), which did not reach statistical significance.Choosing an adequate cannulation site is a critical step in TAAD surgery. In our series, axillary and innominate cannulation were the preferred methods with relatively low complication rates.
A型主动脉夹层作为一种高致死性疾病，仍然是全球心脏外科医生面临的巨大挑战。关于术中决策及其对手术结果的影响，仍存在一些未解决的问题。本研究的目的是比较急性A型主动脉夹层（ATAAD）患者根据插管部位的术后结果。这是一项回顾性队列研究。我们纳入了2002年1月至2023年11月期间所有的ATAAD手术。我们根据插管部位（主动脉、腋动脉、股动脉、无名动脉）定义分组。收集术前、术中和术后变量的数据。我们的主要结局是脊髓损伤（SCI）、卒中发生率和住院死亡率。组间比较采用标准统计检验，并进行了调整多重比较的事后检验。我们确定了127例ATAAD手术。股动脉插管组因出血进行再次手术的比例显著更高（75%，P = 0.0006）。急性肾损伤发生率（P = 0.012）、SCI发生率（P = 0.78）或住院死亡率（P = 0.75）无统计学显著差异。我们的数据表明，腋动脉插管组的卒中发生率较低（3.6%，P = 0.4），但未达到统计学显著性。选择合适的插管部位是TAAD手术中的关键步骤。在我们的系列研究中，腋动脉和无名动脉插管是并发症发生率相对较低的首选方法。
