Double arterial cannulation versus right axillary artery cannulation for acute type A aortic dissection: a retrospective study.
Double arterial cannulation versus right axillary artery cannulation for acute type A aortic dissection: a retrospective study.
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DOI：
10.1186/s13019-021-01714-5
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发表时间：
2021-11-07
影响因子：
1.6
通讯作者：
Wang D
中科院分区：
文献类型：
--
作者：
Zhang H;Xie W;Lu Y;Pan T;Zhou Q;Xue Y;Wang D
急性A型主动脉夹层（ATAAD）手术中的插管策略仍存在争议。我们旨在回顾性分析双动脉插管（DAC）与右腋插管（RAC）治疗ATAAD的安全性和有效性。2016年1月至2018年12月，431例ATAAD患者入组研究。将患者分为DAC组（n = 341）和RAC组（n = 90）。采用倾向评分匹配分析比较两组患者的早、中期疗效。比较两组患者术中血气指标及体外循环参数，以证实DAC的器官保护作用。两组的人口统计学和术前合并症相似，但DAC组的患者年龄小于RAC组（51.55 ± 13.21岁vs. 56.07 ± 12.16岁，P < 0.001）。DAC的肢体灌注不良发生率较高（18.2% vs. 10.0%，P = 0.063），冠状动脉灌注不良发生率较低（5.3% vs. 12.2%，P = 0.019）。两组的体外循环和阻断时间无显著差异。住院死亡率为13.5%（58/431），而两组之间无差异（13.5% vs. 13.3%; P = 0.969）。接受DAC的患者术后卒中发生率较高（5.9% vs. 0%，P = 0.019），术后急性肾损伤（阿基）发生率较低（24.7% vs. 40.3%; P = 0.015）。在平均31.8个月（四分位距，25-45）的随访期内，DAC组的总生存率为81.5%，RAC组为78.0%（P = 0.560）。术中血气结果和体外循环参数显示，DAC组术中尿量多于RAC组（P = 0.05），DAC组的冷却时间（P = 0.04）和复温时间（P = 0.04）短于RAC组。与RAC相比，DAC不会增加手术风险，但可以降低术后阿基的发生率，这可能有利于肾脏保护。在线版本包含补充材料，可通过10.1186/s13019-021-01714-5获得。
Cannulation strategy in surgery for acute type A aortic dissection (ATAAD) remains controversial. We aimed to retrospectively analyze the safety and efficacy of double arterial cannulation (DAC) compared with right axillary cannulation (RAC) for ATAAD. From January 2016 to December 2018, 431 ATAAD patients were enrolled in the study. Patients were divided into DAC group (n = 341) and RAC group (n = 90). Propensity score matching analysis was performed to compare the early and mid-term outcomes between these two groups. To confirm the organ protection effect by DAC, intraoperative blood gas results and cardiopulmonary bypass parameters were compared between the two groups. Demographics and preoperative comorbidities were comparable between two groups, while patients in DAC group were younger than RAC group (51.55 ± 13.21 vs. 56.07 ± 12.16 years, P < 0.001). DAC had a higher incidence of limb malperfusion (18.2% vs. 10.0%, P = 0.063) and lower incidence of coronary malperfusion (5.3% vs. 12.2%, P = 0.019). No significant difference in cardiopulmonary bypass and cross-clamp time was found between the two groups. The in-hospital mortality was 13.5% (58/431), while there was no difference between the two groups (13.5% vs. 13.3%; P = 0.969). Patients who underwent DAC had higher incidence of postoperative stroke (5.9% vs. 0%, P = 0.019) and lower incidence of postoperative acute kidney injury (AKI) (24.7% vs. 40.3%; P = 0.015). During a mean follow-up period of 31.8 (interquartile range, 25–45) months, the overall survival was 81.5% for DAC group and 78.0% for RAC group (P = 0.560). Intraoperative blood gas results and cardiopulmonary bypass parameters showed that DAC group had more intraoperative urine output volume than RAC group (P = 0.05), and the time of cooling (P = 0.04) and rewarming (P = 0.04) were shorter in DAC group. DAC will not increase the surgical risks compared to RAC, but could reduce the incidence of postoperative AKI which may be benefit for renal protection. The online version contains supplementary material available at 10.1186/s13019-021-01714-5.
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