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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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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 |
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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 |
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