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Clinical Trial
. 2019 Feb 6;14(2):e0211900.
doi: 10.1371/journal.pone.0211900. eCollection 2019.

Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience

Chun-Yu Lin  1   2 , Chi-Nan Tseng  1   2 , Hsiu-An Lee  2 , Heng-Tsan Ho  2 , Feng-Chun Tsai  1   2
Affiliations
Clinical Trial

Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience

Chun-Yu Lin et al. PLoS One. .

Abstract

Background: Repair of acute type A aortic dissection (ATAAD) is a complex and emergent cardiovascular surgery that is associated with high perioperative morbidity and mortality. Each cannulation strategy has different benefits and drawbacks during cardiopulmonary bypass. Using a retrospective study design, we aimed to clarify the safety and efficacy of right axillary artery cannulation in combination with femoral artery cannulation compared to single arterial cannulation for ATAAD repair.

Methods: From January 2007 to July 2017, 476 adult patients underwent ATAAD repair at a single institution. Patients were classified into groups according to their cannulation strategy: the double arterial cannulation (DAC) group (n = 377; 79.2%) or single arterial cannulation (SAC) group (n = 99; 20.8%). Preoperative demographics, surgical information, and postoperative recovery were compared between both groups. Survival and freedom from reoperation rates were analyzed using the Kaplan-Meier actuarial method.

Results: Demographics, comorbidities, and surgical procedures were generally homogenous between the two groups, except for sex, age, and rate of extensive aortic repair. Patients who underwent DAC had lower in-hospital mortality (13.5% vs. 25.3%; P = 0.005) and lower incidence of malperfusion-related complications (18.8% vs. 30.3%; P = 0.011) than those who underwent SAC. During multivariate analysis, SAC was identified as an in-hospital mortality predictor (odds ratio, 2.81; 95% confidence interval, 1.52-5.17; P = 0.001), as were preoperative ventilator support, intraoperative extracorporeal membrane oxygenation installation, and postoperative malperfusion-related complications. Three-year cumulative survival and freedom from reoperation rates were 74.8% and 85.3% for the DAC group and 62.6% and 81.1% for the SAC group, respectively (P = 0.010 and 0.430, respectively).

Conclusions: With acceptable short- and mid-term outcomes, DAC is effective and safe for establishing cardiopulmonary bypass during ATAAD repair.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Distribution of cannulation strategies during the study period.
Fig 2
Fig 2
(A) Kaplan-Meier curves of 3-year cumulative survival for 476 patients; and (B) Kaplan-Meier curves of 3-year cumulative survival for 400 patients (excluding those with in-hospital mortality) stratified by cannulation strategies.
Fig 3
Fig 3. Kaplan-Meier curves of 3-year freedom from aortic reoperation stratified by cannulation strategies.
See this image and copyright information in PMC

References

    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. 10.1016/j.jacc.2015.05.029 - DOI - PubMed
    1. Conzelmann LO, Krüger T, Hoffmann I, Rylski B, Easo J, Oezkur M, et al. German Registry for Acute Aortic Dissection Type A (GERAADA): initial results. Herz. 2011;36: 513–524. 10.1007/s00059-011-3512-x - DOI - PubMed
    1. Schachner T, Nagiller J, Zimmer A, Laufer G, Bonatti J. Technical problems and complications of axillary artery cannulation. Eur J Cardiothorac Surg. 2005;27: 634–637. 10.1016/j.ejcts.2004.12.042 - DOI - PubMed
    1. Buonocore M, Amarelli C, Scardone M, Caiazzo A, Petrone G, Majello L, et al. Cerebral perfusion issues in acute type A aortic dissection without preoperative malperfusion: how do surgical factors affect outcomes? Eur J Cardiothorac Surg. 2016;50: 652–659. 10.1093/ejcts/ezw152 - DOI - PubMed
    1. Fusco DS, Shaw RK, Tranquilli M, Kopf GS, Elefteriades JA. Femoral cannulation is safe for type A dissection repair. Ann ThoracSurg. 2004;78: 1285–1289. https://plu.mx/plum/a/?doi=10.1016/j.athoracsur.2004.04.072&theme=plum-j... 10.1016/j.athoracsur.2004.04.072 - DOI - PubMed

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