Cargando…

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

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Lin, Chun-Yu, Tseng, Chi-Nan, Lee, Hsiu-An, Ho, Heng-Tsan, Tsai, Feng-Chun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364944/
https://www.ncbi.nlm.nih.gov/pubmed/30726302
http://dx.doi.org/10.1371/journal.pone.0211900
_version_ 1783393343034621952
author Lin, Chun-Yu
Tseng, Chi-Nan
Lee, Hsiu-An
Ho, Heng-Tsan
Tsai, Feng-Chun
author_facet Lin, Chun-Yu
Tseng, Chi-Nan
Lee, Hsiu-An
Ho, Heng-Tsan
Tsai, Feng-Chun
author_sort Lin, Chun-Yu
collection PubMed
description 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.
format Online
Article
Text
id pubmed-6364944
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-63649442019-02-22 Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience Lin, Chun-Yu Tseng, Chi-Nan Lee, Hsiu-An Ho, Heng-Tsan Tsai, Feng-Chun PLoS One Research Article 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. Public Library of Science 2019-02-06 /pmc/articles/PMC6364944/ /pubmed/30726302 http://dx.doi.org/10.1371/journal.pone.0211900 Text en © 2019 Lin et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Lin, Chun-Yu
Tseng, Chi-Nan
Lee, Hsiu-An
Ho, Heng-Tsan
Tsai, Feng-Chun
Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience
title Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience
title_full Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience
title_fullStr Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience
title_full_unstemmed Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience
title_short Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience
title_sort double arterial cannulation strategy for acute type a aortic dissection repair: a 10-year single-institution experience
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364944/
https://www.ncbi.nlm.nih.gov/pubmed/30726302
http://dx.doi.org/10.1371/journal.pone.0211900
work_keys_str_mv AT linchunyu doublearterialcannulationstrategyforacutetypeaaorticdissectionrepaira10yearsingleinstitutionexperience
AT tsengchinan doublearterialcannulationstrategyforacutetypeaaorticdissectionrepaira10yearsingleinstitutionexperience
AT leehsiuan doublearterialcannulationstrategyforacutetypeaaorticdissectionrepaira10yearsingleinstitutionexperience
AT hohengtsan doublearterialcannulationstrategyforacutetypeaaorticdissectionrepaira10yearsingleinstitutionexperience
AT tsaifengchun doublearterialcannulationstrategyforacutetypeaaorticdissectionrepaira10yearsingleinstitutionexperience