Impact of Perfusion Strategy on Outcome After Repair for Acute Type A Aortic Dissection

Etz, Christian D.; Aspern, Konstantin von; Silva, Jaqueline Da Rocha e; Girrbach, Felix; Leontyev, Sergey; Luehr, Maximilian; Misfeld, Martín; Borger, Michael A.; Mohr, Friedrich W.

doi:10.1016/j.athoracsur.2013.07.034

Cited by 77 publications

(59 citation statements)

References 17 publications

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“…Our cannulation strategy for initial bypass had no impact on mortality. While some studies show a positive effect with central cannulation (10) other studies could not demonstrate any benefit (1,(11)(12)(13). In a meta-analysis from Patris et al femoral cannulation had a negative outcome, but was used mainly in critically ill patients in hemodynamic collapse when institution of cardiopulmonary bypass was required rapidly (14).…”

Section: Discussionmentioning

confidence: 99%

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Klotz¹,

Bucsky²,

Richardt³

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The purpose of this study was to evaluate the single-center experience in initial femoral versus central cannulation of the extracorporeal circulation for acute aortic dissection type A (AADA). Conclusions: AADA can be operated with both femoral and central cannulation with similar results. Risk for early mortality was driven by the preoperative clinical and hemodynamic status before operation rather than the cannulation technique. Methods

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Section: Discussionmentioning

confidence: 99%

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Klotz¹,

Bucsky²,

Richardt³

et al. 2016

Ann. Cardiothorac. Surg.

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show abstract

“…In particular, antegrade perfusion through the true lumen (via axillary cannulation or central aortic cannulation) has been reported to be associated with better survival. 20 In general, both ACP and RCP have advantages and disadvantages with regard to brain protection. ACP could be used to provide a reliable cerebral circulation, but it requires the placement of additional cannulas on the arch branches, which potentially increases the chance of embolism or worsening of malperfusion.…”

Section: Propensity-matched Pairs Analysismentioning

confidence: 99%

Brain Protection During Ascending Aortic Repair for Stanford Type A Acute Aortic Dissection Surgery

Tokuda¹,

Matsubara

Motomura

et al. 2014

Circ J

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“…In Christian and co-workers’ study, antegrade perfusion to the true lumen appeared to be associated with superior long-term survival after hospital discharge 11. Based on our evaluation, we believe subclavian cannulation could provide better perfusion, not only for the brain but also for the myocardium and other visceral organs, leading to lower mortality rates and better recovery following AADA procedures.…”

Section: Resultsmentioning

confidence: 59%

Subclavian artery cannulation provides better myocardial protection in conventional repair of acute type A aortic dissection: experience from a single medical centre in Taiwan

Hsu

Chen

Tsai

et al. 2016

CVJA

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SummaryBackgroundAlthough many reports have detailed the advantages and disadvantages between femoral and subclavian arterial cannulations for acute aortic dissection type A (AADA), the confounding factors caused by disease severity and surgical procedures could not be completely eliminated. We compared femoral and subclavian artery cannulation and report the results for reconstruction of only the ascending aorta.MethodsFrom January 2003 to December 2010, 51 AADA cases involving reconstruction of only the ascending aorta were retrospectively reviewed and categorised on the basis of femoral (n = 26, 51%) or subclavian (n = 25, 49%) arterycannulation. Bentall’s procedures, arch reconstruction and hybrid operations with stent-grafts were all excluded to avoid confounding factors due to dissection severity. Surgical results, postoperative mortality, and short- and mid-term outcomes were compared between the groups.ResultsSubclavian cannulation had a lower incidence of cerebral and myocardial injury and lower hospital mortality than femoral cannulation (8 vs 34%, p = 0.04). Ventilation duration as well as intensive care unit (ICU) and hospital stay were also shorter with subclavian cannulation. Risk factors for hospital mortality included pre-operative respiratory failure (odds ratio: 12.84), peri-operative cardiopulmonary bypass (CPB) time > 200 minutes (odds ratio: 13.49), postoperative acidosis (pH < 7.2, odds ratio: 88.63), and troponin I > 2.0 ng/ml (odds ratio: 20.08). The overall hospital mortality rate was 21%. The 40 survivors were followed up for three years with survival of 75% at one year and 70% at three years.ConclusionsOur results show that subclavian cannulation had a lower incidence of cerebral and myocardial injury as well as better postoperative recovery and lower hospital mortality rates for reconstruction of only the ascending aorta.

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Impact of Perfusion Strategy on Outcome After Repair for Acute Type A Aortic Dissection

Cited by 77 publications

References 17 publications

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Brain Protection During Ascending Aortic Repair for Stanford Type A Acute Aortic Dissection Surgery

Subclavian artery cannulation provides better myocardial protection in conventional repair of acute type A aortic dissection: experience from a single medical centre in Taiwan

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