Does the arterial cannulation site for circulatory arrest influence stroke risk?
Does the arterial cannulation site for circulatory arrest influence stroke risk?
复制标题
DOI：
10.1016/j.athoracsur.2004.04.063
复制
发表时间：
2004-10-01
影响因子：
4.6
通讯作者：
Cosgrove, DM
中科院分区：
文献类型：
--
作者：
Svensson, LG;Blackstone, EH;Cosgrove, DM
背景。我们研究了在低温停循环期间，与在其他部位插管相比，侧移植物的腋窝/锁骨下动脉流入是否会降低中风的风险。方法。 1993年1月至2003年5月期间，针对复杂的成人心脏问题进行了1,352例循环停止手术。 1,336 例手术中使用了单一动脉流入插管部位，这些形成了比较分析的基础。 299 例手术中插管部位为腋窝加移植物，471 例手术为主动脉直接插管，375 例为股动脉插管，24 例为无名手术，167 例为腋窝或锁骨下无侧移植物插管。933 例（69%）使用逆行脑灌注。共有 272 例（20%）为急诊，432 例（32%）为再次手术，439 例（32%）为解剖。共有 617 例（46%）进行了主动脉瓣置换术，其中 1,160 例（87%）进行了升主动脉瓣置换，415 例进行了弓形主动脉瓣置换（31%），以及 248 例进行了降主动脉瓣置换（18%）。适应症还包括动脉硬化（n = 301）和主动脉钙化（n = 278）。通过倾向匹配进行主要比较，其次通过多变量逻辑回归确定中风或医院死亡的危险因素。结果。 6.1% 的患者 (81/1,336) 发生中风：4.0% (12/299) 的患者接受腋窝加移植物，6.7% 的患者接受直接插管 (69/1,037；p = 0.09；倾向匹配对中 p = 0.05)。与中风相关的手术变量包括直接主动脉插管、主动脉硬化、降主动脉修复和二尖瓣置换术。进行股骨插管的患者的医院死亡风险（11%；42/375）高于腋窝加移植的患者（7.0%；21/299；p = 0.06；倾向匹配对中p = 0.02）。结论。腋窝流入加移植物可减少中风，是我们进行需要停循环的复杂心脏和心主动脉手术的首选方法。有选择地使用逆行或顺行灌注。 (C) 2004 年，胸外科医师协会。
Background. We investigated whether axillary/ subclavian artery inflow with a side graft decreases the risk of stroke versus cannulation at other sites during hypothermic circulatory arrest. Methods. Between January 1993 and May 2003, 1,352 operations with circulatory arrest were performed for complex adult cardiac problems. A single arterial inflow cannulation site was used in 1,336 operations, and these formed the basis for comparative analyses. Cannulation sites were axillary plus graft in 299 operations, direct cannulation of the aorta in 471, femoral in 375, innominate in 24, and axillary or subclavian without a side graft in 167. Retrograde brain perfusion was used in 933 (69%). A total of 272 (20%) were for emergencies, 432 (32%) were reoperations, and 439 (32%) were for dissections. A total of 617 (46%) had aortic valve replacement and 1,160 (87%) ascending, 415 arch (31%), and 248 descending (18%) aortic replacements. Indications also included arteriosclerosis (n = 301) and calcified aorta (n = 278). Primary comparisons were made by using propensity matching, and, secondarily, risk factors for stroke or hospital mortality were identified by multivariable logistic regression. Results. Stroke occurred in 6.1% of patients (81/1,336): 4.0% (12/299) of those had axillary plus graft and 6.7% who had direct cannulation (69/1,037; p = 0.09; p = 0.05 among propensity-matched pairs). Operative variables associated with stroke included direct aortic cannulation, aortic arteriosclerosis, descending aorta repair, and mitral valve replacement. The risk of hospital mortality was higher (11%; 42/375) for patients who had femoral cannulation than axillary plus graft (7.0%; 21/299; p = 0.06; p 0.02 among propensity-matched pairs). Conclusions. Axillary inflow plus graft reduces stroke and is our method of choice for complex cardiac and cardioaortic operations that necessitate circulatory arrest. Retrograde or antegrade perfusion is used selectively. (C) 2004 by The Society of Thoracic Surgeons.