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

Klotz, Stefan; Bucsky, B.; Richardt, Doreen; Petersen, M.; Sievers, Hans H.

doi:10.21037/acs.2016.07.09

Cited by 12 publications

(14 citation statements)

References 18 publications

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“…VA-ECMO can provide hemodynamic support that enables patients to recover from reversible myocardial injury. Historically, VA-ECMO was usually not recommended in patients with aortic disease because the intravascular cannulation and retrograde flow might exacerbate lesions of the aortic wall, and the use of anticoagulation might increase the risk of bleeding (8)(9)(10). However, the use of VA-ECMO in patients suffering from aortic disease with PCS has been poorly reported.…”

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confidence: 99%

“…However, the use of VA-ECMO in patients suffering from aortic disease with PCS has been poorly reported. Historically, VA-ECMO was usually not recommended in patients with aortic disease because the intravascular cannulation and retrograde flow might exacerbate lesions of the aortic wall, and the use of anticoagulation might increase the risk of bleeding (8)(9)(10). As left ventricular devices are not available in China, ECMO is the major alternative for temporary mechanical circulatory support in patients who undergo cardiac procedures with PCS.…”

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confidence: 99%

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Veno‐Arterial Extracorporeal Membrane Oxygenation Support in Patients Undergoing Aortic Surgery

et al. 2017

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Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an option for mechanical support for patients with postcardiotomy cardiogenic shock (PCS). However, the use of VA-ECMO in patients suffering from aortic disease with PCS has not been greatly reported. This is a retrospective review of adult patients undergoing aortic surgery who received VA-ECMO support to treat refractory PCS from August 2009 to May 2016. A total of 36 patients who underwent aortic surgery with VA-ECMO support for refractory PCS were included. Preoperative, perioperative, and postoperative variables were assessed and analyzed for possible correlation with in-hospital mortality. After a mean duration of 3.6 ± 2.9 days, 24 patients (67%) were weaned off VA-ECMO, and 18 patients (50%) were discharged from the hospital. The overall in-hospital mortality was 50%. The main cause of death was multiple organ dysfunction. The survivors had a lower level of preoperative creatine kinase-MB (CK-MB), a higher rate of antegrade cannulation, and a lower lactate level at 12 h, respectively. Relevant factors for in-hospital mortality were retrograde-flow cannulation (odds ratio [OR], 2.49), peak lactate levels greater than 20 mmol/L (OR, 5.0), and preoperative CK-MB greater than 100 IU/L (OR, 6.40). Antegrade cannulation may provide better perfusion and should be emphasized to improve outcomes. Additionally, levels of peak serum lactate and preoperative CK-MB may be relevant factors for in-hospital mortality in aortic patients with PCS.

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confidence: 99%

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confidence: 99%

Veno‐Arterial Extracorporeal Membrane Oxygenation Support in Patients Undergoing Aortic Surgery

et al. 2017

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“…15 FAC is the traditional, fastest and easiest accessible site, therefore, its use is preferred in haemodynamically unstable patients instead of axillary approach which may occasionally be too time-consuming. 16,17 The use of FAC, primarily due to a retrograde flow in the aorta, has the maximum rate of mortality, false lumen perfusion, limb ischaemia, coronary and cerebral embolisation and organ malperfusion. Axillary artery cannulation technique has a theoretical advantage in providing an antegrade flow during the cooling period.…”

Section: Discussionmentioning

confidence: 99%

Direct true lumen versus conventional cannulation for acute type a aortic dissection

Wahid¹,

Shahabuddin²,

Amanullah³

et al. 2020

J Pak Med Assoc

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Acute type-A aortic dissection is a surgical emergency and has a high rate of short-term mortality. Aortic dissection is highly under-reported in Pakistan. With the technological developments in its management, arterial cannulation technique of direct true lumen cannulation has emerged with improved outcomes. We aimed to compare the mortality and morbidity outcomes between direct true lumen and conventional cannulation techniques for arterial access in patients with acute type-A aortic dissection under a single-centre retrospective review from 2007 to 2017. Mean age of the participants was 43.3±11.6 vs 45±12.4 years with males being dominant in both groups. Frequency of overall morbidity was high in conventional cannulation group (Group-B), though it did not attain statistical significance, (p>0.999). Mortality rate was also high in Group-B (10% vs 30%), (p=0.582). Direct true lumen cannulation is an equally reliable option for establishing cardiopulmonary bypass due to reduced mortality and morbidity and may be given preference when dissection is extending into femoral and innominate arteries.

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“…Our study shows that aortic arch cannulation with the guidance of TEE has a positive effect on 30 day mortality. Stefan and colleagues [ 23 ] found that the cannulation strategy used for the initial bypass has no impact on mortality, even though the femoral cannulation is performed more often in a sick patient group, as categorized by ASA classification. In another study, the risk for early mortality was driven by the preoperative clinical and hemodynamic status before the operation rather than by the cannulation technique [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…With adequate cerebral perfusion and cerebral monitoring using the bilateral cerebral oxygen, a moderate hypothermic arrest with temperatures between 25 °C and 27 °C is acceptable in both groups. In the study by Stefan and colleagues [ 23 ], no differences in neurologic symptoms regarding the perfusion strategy were found. In another singer-center study by Stefan and colleagues [ 24 ], their data showed a new neurologic event in 11% of all patients, which did not differ between femoral and central cannulation.…”

Section: Discussionmentioning

confidence: 99%

Aortic arch cannulation with the guidance of transesophageal echocardiography for Stanford type A aortic dissection

Xiao

Shi

et al. 2018

J Cardiothorac Surg

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BackgroundAortic arch cannulation for an antegrade central perfusion during the surgery for Stanford type A aortic dissection can be performed within median sternotomy. We summarize the safety and convenient profile of the central cannulation strategy using the guidance of transesophageal echocardiography (TEE) in comparison to traditional femoral cannulation strategy.MethodsSixty-two patients with acute Stanford type A aortic dissection underwent aortic arch surgery in our hospital. All the patients were operated by the same surgeon. Cannulation was performed in 33 patients through the aortic arch under the guidance of TEE (Group A) and in 29 patients through the femoral artery (Group F). Under moderate hypothermic circulatory arrest, the brain is continuously perfused in an anterograde manner through the brachiocephalic and left common carotid arteries. Preoperative characeristics and surgical information were collected for each patient. Additionally, 30-day mortality rate and the incidence of the temporary neurological dysfunction were recorded as the outcomes. To compare the categorical variables, we used the chi-squared test. Continuous variables were compared using the t-test.ResultsPreoperative characteristics were almost similar between the two groups. The mean operation time (7.33 ± 1.14 h vs. 8.93 ± 2.59 h, P = 0.002) and the mean cardiopulmonary bypass (CPB) time (260.97 ± 45.14 min vs. 298.28 ± 95.89 min, P = 0.024) were significantly shorter in Group A than those in Group F. The 30-day mortality rates were 9.09 and 27.59% in Groups A and F, respectively (P = 0.057). And the incidences of temporary neurological dysfunction were 39.39 and 65.52% in Group A and F, respectively (P = 0.040).ConclusionsAortic arch cannulation with the guidance of TEE during the aortic arch surgery is a simple, fast, safe, and less invasive technique for establishing cardiopulmonary bypass for Stanford type A aortic dissection.

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

Cited by 12 publications

References 18 publications

Veno‐Arterial Extracorporeal Membrane Oxygenation Support in Patients Undergoing Aortic Surgery

Veno‐Arterial Extracorporeal Membrane Oxygenation Support in Patients Undergoing Aortic Surgery

Direct true lumen versus conventional cannulation for acute type a aortic dissection

Aortic arch cannulation with the guidance of transesophageal echocardiography for Stanford type A aortic dissection

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