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The cannulation strategy in surgery for acute type A dissection

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...

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Autores principales: Abe, Tomonobu, Usui, Akihiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Japan 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214928/
https://www.ncbi.nlm.nih.gov/pubmed/27650659
http://dx.doi.org/10.1007/s11748-016-0711-7
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author Abe, Tomonobu
Usui, Akihiko
author_facet Abe, Tomonobu
Usui, Akihiko
author_sort Abe, Tomonobu
collection PubMed
description 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.
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spelling pubmed-52149282017-01-24 The cannulation strategy in surgery for acute type A dissection Abe, Tomonobu Usui, Akihiko Gen Thorac Cardiovasc Surg Current Topics Review Article 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. Springer Japan 2016-09-20 2017 /pmc/articles/PMC5214928/ /pubmed/27650659 http://dx.doi.org/10.1007/s11748-016-0711-7 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Current Topics Review Article
Abe, Tomonobu
Usui, Akihiko
The cannulation strategy in surgery for acute type A dissection
title The cannulation strategy in surgery for acute type A dissection
title_full The cannulation strategy in surgery for acute type A dissection
title_fullStr The cannulation strategy in surgery for acute type A dissection
title_full_unstemmed The cannulation strategy in surgery for acute type A dissection
title_short The cannulation strategy in surgery for acute type A dissection
title_sort cannulation strategy in surgery for acute type a dissection
topic Current Topics Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214928/
https://www.ncbi.nlm.nih.gov/pubmed/27650659
http://dx.doi.org/10.1007/s11748-016-0711-7
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