A comparison of single and double arterial cannulation for cardiopulmonary bypass for acute type A aortic surgery: A single center,retrospective observational study

Abstract

Background: Acute type A aortic dissection (ATAAD) is a cardiovascular emergency and has high mortality and morbidity. We retrospectively compared the effects on outcomes of single arterial cannulation via axillary artery (AAC) with double arterial cannulation via axillary and femoral artery (DAC) in patients who underwent cardiopulmonary bypass (CPB) for ATAAD.

Methods: Between January 2017 and May 2021, four hundred 29 patients who underwent aortic arch repair with circulatory arrest for ATAAD were divided into AAC group (n = 283) and DAC group (n = 146). The propensity score-matched (PSM) analysis were performed to compare the characteristics and outcomes of the groups.

Results: After PSM (n = 137 in each), the DAC group had a longer duration of CPB (229 vs 244, p = 0.011), aortic cross-clamp time (121 vs 149, p < 0.001), durations of Intensive Care Unit (ICU) stay (7 vs 8, p = 0.014) and hospital stay (19 vs 25, p < 0.001) compared with AAC group. The incidences of dialysis (21% vs. 31%, p = 0.073), postoperative stroke (9% vs 15%, p = 0.143), ECMO support (2% vs 7%, p = 0.077), in-hospital mortality (7% vs 14%, p = 0.071) and follow-up mortality (10% vs 19%, p = 0.059) showed no significant difference between two groups. Multivariate logistic regression analysis showed postoperative ECMO (OR: 16.69, 95% CI: 1.78–156.29; p = 0.014) or stroke (OR: 11.34, 95% CI: 2.64–48.72; p < 0.001) were associated with in-hospital mortality. Univariate Cox regression results showed stroke history (OR: 4.61, 95% CI: 1.90–11.16; p = 0.001), aortic valvuloplasty (OR: 0.21, 95% CI: 0.07–0.59; p = 0.003), postoperative ALT day1 (OR: 1.00, 95% CI: 1.00–1.00; p = 0.008), ECMO (OR: 16.30, 95% CI: 4.78–55.61; p < 0.001), tracheotomy (OR: 3.78, 95% CI: 1.08–13.20; p = 0.037), postoperative stroke (OR: 4.61, 95% CI: 1.90–11.16; p < 0.001) and re-exploration for bleeding (OR: 3.52, 95% CI: 1.01–12.27; p = 0.048) were associated to follow-up mortality.

Conclusions: For surgical treatment of ATAAD with CPB when compared to double axillary and femoral artery, single axillary cannulation was associated with shorter durations of CPB and ACC as well as ICU and hospital stays but no with significant difference in mortality.

Keywords

aortic dissection cannulation cardiopulmonary bypass femoral axillary

Get full access to this article

View all access options for this article.

References

Maisat

Siriratwarangkul

Charoensri

, et al. Perioperative risk factors for delayed extubation after acute type A aortic dissection surgery. J Thorac Dis 2020; 12: 4796–4804. DOI: 10.21037/jtd-20-742

Zdravkovic

Nesic

Zivkovic

, et al. Risk factors for neurological dysfunctions after surgical repair of acute aortic dissection type A. Kardiochir Torakochirurgia Pol 2020; 17: 70–75. DOI: 10.5114/kitp.2020.97261

Lin

Tseng

Lee

, et al. Double arterial cannulation strategy for acute type A aortic dissection repair: a 10-year single-institution experience. PLoS One 2019; 14: e0211900. DOI: 10.1371/journal.pone.0211900

Ram

Krupik

Lipey

, et al.

Is axillary better than femoral artery cannulation in repair of acute type A aortic dissection?

Innovations (Phila) 2019; 14: 124–133. DOI: 10.1177/1556984519836879

Lillehei

Cardozo

. Use of median sternotomy with femoral artery cannulation in open cardiac surgery. Surg Gynecol Obstet 1959; 108: 706–714.

Laas

Heinemann

Schaefers

, et al. Management of thoracoabdominal malperfusion in aortic dissection. Circulation 1991; 84: Iii20–24.

Shimokawa

Takanashi

Ozawa

, et al. Management of intraoperative malperfusion syndrome using femoral artery cannulation for repair of acute type A aortic dissection. Ann Thorac Surg 2008; 85: 1619–1624. DOI: 10.1016/j.athoracsur.2008.01.048

Van Arsdell

David

Butany

. Autopsies in acute type A aortic dissection. Surgical implications. Circulation 1998; 98: II299–302.

Borst

. Axillary artery for extracorporeal circulation. J Thorac Cardiovasc Surg 1995; 110: 1775. DOI: 10.1016/s0022-5223(95)70050-1

10.

Strauch

Spielvogel

Lauten

, et al. Technical advances in total aortic arch replacement. Ann Thorac Surg 2004; 77: 581–589; discussion 589-590. DOI: 10.1016/s0003-4975(03)01342-0

11.

Erbel

Aboyans

Boileau

, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European society of cardiology (ESC). Eur Heart J 2014; 35: 2873–2926. DOI: 10.1093/eurheartj/ehu281

12.

Benedetto

Mohamed

Vitulli

, et al. Axillary versus femoral arterial cannulation in type A acute aortic dissection: evidence from a meta-analysis of comparative studies and adjusted risk estimates. Eur J Cardiothorac Surg 2015; 48: 953–959. DOI: 10.1093/ejcts/ezv035

13.

Kusadokoro

Kimura

Hori

, et al. Utility of double arterial cannulation for surgical repair of acute type A dissection. Eur J Cardiothorac Surg 2020; 57: 1068–1075. DOI: 10.1093/ejcts/ezaa007

14.

Zhang

Xie

, et al. Double arterial cannulation versus right axillary artery cannulation for acute type A aortic dissection: a retrospective study. J Cardiothorac Surg 2021; 16: 326. DOI: 10.1186/s13019-021-01714-5

15.

Kim

Lee

, et al. Axillary artery cannulation reduces early embolic stroke and mortality after open arch repair with circulatory arrest. J Thorac Cardiovasc Surg 2020; 159: 772–778.e4. DOI: 10.1016/j.jtcvs.2019.02.112

16.

Talwar

Wiadji

Mathur

. Experience with the axillary artery as an arterial cannulation site in patients with acute type A aortic dissection. Heart Lung Circ 2019; 28: 342–347. DOI: 10.1016/j.hlc.2018.03.019

17.

Abe

Usui

. The cannulation strategy in surgery for acute type A dissection. Gen Thorac Cardiovasc Surg 2017; 65: 1–9. DOI: 10.1007/s11748-016-0711-7

18.

Xia

Cao

Xie

, et al. Cannulation strategies in type A aortic dissection: a novel insight narrative review. J Thorac Dis 2021; 13: 2551–2562. DOI: 10.21037/jtd-21-411

19.

, et al. A multidetector CT angiography study of variations in the circle of Willis in a Chinese population. J Clin Neurosci 2011; 18: 379–383. DOI: 10.1016/j.jocn.2010.07.137

20.

Huang

Chen

, et al. Combined femoral and axillary perfusion strategy for stanford type A aortic dissection repair. J Cardiothorac Surg 2020; 15: 326. DOI: 10.1186/s13019-020-01371-0

21.

Leshnower

. Cannulation strategies, circulation management and neuroprotection for type A intramural hematoma: tips and tricks. Ann Cardiothorac Surg 2019; 8: 561–566. DOI: 10.21037/acs.2019.08.08

22.

Schachner

Nagiller

Zimmer

, et al. Technical problems and complications of axillary artery cannulation. Eur J Cardiothorac Surg 2005; 27: 634–637. DOI: 10.1016/j.ejcts.2004.12.042

23.

Gaudino

Girardi

. Commentary: axillary artery cannulation for acute type A aortic dissection. J Thorac Cardiovasc Surg 2019; 158: 660–661. DOI: 10.1016/j.jtcvs.2018.11.125

24.

Minatoya

Ogino

Matsuda

, et al. Rapid and safe establishment of cardiopulmonary bypass in repair of acute aortic dissection: improved results with double cannulation. Interact Cardiovasc Thorac Surg 2008; 7: 951–953. DOI: 10.1510/icvts.2007.171546.

25.

Chen

Zhang

Yang

, et al. Predicting intensive care unit length of stay after acute type A aortic dissection surgery using machine learning. Front Cardiovasc Med 2021; 8: 675431. DOI: 10.3389/fcvm.2021.675431

26.

Lemaire

Chao

Salgueiro

, et al. Femoral arterial cannulation remains a safe and reliable option for aortic dissection repair. J Thorac Dis 2021; 13: 1005–1010. DOI: 10.21037/jtd-20-2549

27.

Gulbins

Pritisanac

Ennker

. Axillary versus femoral cannulation for aortic surgery: enough evidence for a general recommendation? Ann Thorac Surg 2007; 83: 1219–1224. DOI: 10.1016/j.athoracsur.2006.10.068