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Review
. 2017 Jan;65(1):1-9.
doi: 10.1007/s11748-016-0711-7. Epub 2016 Sep 20.

The cannulation strategy in surgery for acute type A dissection

Tomonobu Abe  1 , Akihiko Usui  2
Affiliations
Review

The cannulation strategy in surgery for acute type A dissection

Tomonobu Abe et al. Gen Thorac Cardiovasc Surg. 2017 Jan.

Abstract

The rates of mortality and morbidity remain high in surgery for acute type A dissection. There is controversy regarding the best cannulation strategy for achieving good clinical results. Each cannulation technique has different anatomical characteristics and a different flow pattern inside the aorta during cardiopulmonary bypass. Some adverse, clinically important outcomes may be related to events at this time. Femoral artery cannulation, axillary artery cannulation, and central aortic cannulation are the three major cannulation strategies that are adopted in many centers in the world. Accumulating results from comparative studies between right axillary artery cannulation and femoral artery cannulation show that right axillary artery cannulation is associated with better clinical outcomes. However, all of the studies have been retrospective, and few studies have compared the results of other combinations of cannulation strategies. Observational studies using newer monitoring techniques clearly show that no perfusion strategy is perfect or free from complications. In summary, the evidence is insufficient to make a strong recommendation regarding cannulation strategies. Based on the fairly consistent results of retrospective studies, more surgeons are tending to switch from a retrograde perfusion strategy to adopt an antegrade perfusion strategy. Regardless of the routine cannulation strategy that is adopted, careful monitoring and a swift response to adverse events are necessary. The further accumulation of evidence is warranted.

Keywords: Aorta; Axillary artery; Cardiopulmonary bypass; Dissecting aneurysm; Femoral artery.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
30-day mortality rate of surgery for acute type A dissection in the Japanese Association for Thoracic Surgery annual surveys. Ascending/Hemiarch, replacement of the ascending aorta and hemiarch replacement; ascending and aortic root, replacement of the ascending aorta and aortic root; ascending and aortic arch, replacement of the ascending aorta and aortic arch
Fig. 2
Fig. 2
Schematic illustration of comparative studies in cannulation strategy in surgery for acute type A dissection. * p < 0.05; #Risk ratio was calculated by authors from published data. Note, this is not a formal report of network meta-analysis. Literature search was not systematically done
See this image and copyright information in PMC

References

    1. El-Hamamsy I, Ouzounian M, Demers P, McClure S, Hassan A, Dagenais F, et al. State-of-the-art surgical management of acute type A aortic dissection. Can J Cardiol. 2016;32:100–109. doi: 10.1016/j.cjca.2015.07.736. - DOI - PubMed
    1. Bonser RS, Ranasinghe AM, Loubani M, Evans JD, Thalji NM, Bachet JE, et al. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol. 2011;58:2455–2474. doi: 10.1016/j.jacc.2011.06.067. - DOI - PubMed
    1. Committee for Scientific Affairs TJAfTS. Masuda M, Kuwano H, Okumura M, Arai H, Endo S, et al. Thoracic and cardiovascular surgery in Japan during 2013: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2015;63:670–701. - PMC - PubMed
    1. Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol. 2015;66:350–358. doi: 10.1016/j.jacc.2015.05.029. - DOI - PubMed
    1. Kouhcoukos NT, Blackstone EH, Hanley FL, Kirklin JK. Kirklin/Barratt-Boyes cardiac surgery: Elsevier, 2012.

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