Right axillary and femoral artery perfusion with mild hypothermia for aortic arch replacement

Guo, Jige; Wang, Yue; Zhu, Jihong; Cao, Jie; Chen, Zili; Li, Zhijun; Qian, Ximing

doi:10.1186/1749-8090-9-94

Cited by 10 publications

(10 citation statements)

References 23 publications

(27 reference statements)

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“…This corroborated our results. Guo et al 19 stated that connection of selective brain perfusion is easier performed in axillary cannulation. Tiwari et al 20 showed that cannulation in ascending aorta bears the risk of cannulating a false lumen leading to progression of dissection.…”

Section: Discussionmentioning

confidence: 99%

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

et al. 2019

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Objectives: The aim of this study was to evaluate independent risk factors predictive for mortality of patients with Stanford A acute aortic dissection. Methods: From January 2006 to March 2015, a total of 240 consecutive patients diagnosed with acute Stanford A acute aortic dissection underwent surgical aortic repair in our center. After analysis of pre- and perioperative variables, univariate logistic and multivariate logistic regression analyses were performed for mortality of patients. Subsequently, Kaplan–Meier estimation analysis of short- and long-term survival of these variables was carried out. Results: Primary entry tear in descending aorta (odds ratio = 4.71, p = 0.021), preoperative international normalized ratio higher than 1.2 (odds ratio = 7.36, p = 0.001), additional coronary artery bypass grafting (odds ratio = 3.39, p = 0.003), cannulation in ascending aorta (odds ratio = 3.22, p = 0.005), preoperative neurological coma (odds ratio = 3.30, p = 0.003), and reduced perfusion (odds ratio = 2.91, p = 0.006) as well as prolonged reperfusion time (odds ratio = 3.36, p = 0.002) showed to be independent predictors for early mortality as well as for late mortality (hazard ratio of all variables p < 0.05). Kaplan–Meier survival estimation analysis with up to 9-year-follow-up in terms of these risk factors showed significantly poorer short- and long-term survival (log-rank and Breslow test all p < 0.05). Conclusion: Our study revealed that early and late mortality of patients with Stanford A acute aortic dissection surgery was significantly influenced by preoperative and perioperative variables as independent predictors especially of variables displaying coronary, cerebral, and visceral malperfusion. Also, short- and long-term survival of patients was significantly poorer in terms of these risk factors.

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Section: Discussionmentioning

confidence: 99%

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

et al. 2019

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“…Distal perfusion through the descending aorta or femoral artery has previously been used to minimize damage to organs [44, 45]. However, this technique is associated with risk of poor occlusion, which seriously interferes with the operating field and leads to false lumen perfusion during femoral artery cannulation.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Inferior Vena caval Perfusion for Total Aortic arch Replacement Surgery (RIVP-TARS): study protocol for a multicenter, randomized controlled trial

Lin

Tan

Yao

et al. 2019

Trials

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Background During total aortic arch replacement surgery (TARS) for patients with acute type A aortic dissection, the organs in the lower body, such as the viscera and spinal cord, are at risk of ischemia even when antegrade cerebral perfusion (ACP) is performed. Combining ACP with retrograde inferior vena caval perfusion (RIVP) during TARS may improve outcomes by providing the lower body with oxygenated blood. Methods This study is designed as a multicenter, computer-generated, randomized controlled, assessor-blind, parallel-group study with a superiority framework in patients scheduled for TARS. A total of 636 patients will be randomized on a 1:1 basis to a moderate hypothermia circulatory arrest (MHCA) group, which will receive selective ACP with moderate hypothermia during TARS; or to an RIVP group, which will receive the combination of RIVP and selective ACP under moderate hypothermia during TARS. The primary outcome will be a composite of early mortality and major complications, including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. All patients will be analyzed according to the intention-to-treat protocol. Discussion This study aims to assess whether RIVP combined with ACP leads to superior outcomes than ACP alone for patients undergoing TARS under moderate hypothermia. This study seeks to provide high-quality evidence for RIVP to be used in patients with acute type A aortic dissection undergoing TARS. Trial registration Clinicaltrials.gov, ID: NCT03607786 . Registered on 30 July 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3319-2) contains supplementary material, which is available to authorized users.

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“…Clinical studies have confirmed that DAC can provide satisfactory cerebral and distal organ protection and avoid deep hypothermia-related side effects (56,57). The greatest advantage of DAC is that the RAAC can make up for the femoral artery-induced false cavity perfusion and that FAC can compensate for the insufficient flow of the RAAC.…”

Section: Double Arterial Cannulation (Dac)mentioning

confidence: 97%

Cannulation strategies in type A aortic dissection: a novel insight narrative review

Xia¹,

Cao²,

Xie³

et al. 2021

J Thorac Dis

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This review highlights vital details that can be easily overlooked and discuss how to identify and fix failed cannulation from another novel insight. Appropriate arterial cannulation strategy during cardiopulmonary bypass (CPB) in Stanford type A aortic dissection (AAD) is highly necessary to reach satisfactory perfusion effects and appreciable clinical outcomes. Despite several previously published reviews on cannulation strategies in AAD, most focus on the advantages and disadvantages by comparing various cannulation strategies. In fact, most of evidence came from retrospective studies. More importantly, however, some important details and novel approaches maybe overlooked due to variety reasons. These overlooked details also make sense in clinical practice. Papers related to cannulation refer to type AAD were retrieved and analyzed from the PubMed and Medline database. The key words such as "aortic dissection", "cannula", "cannulation", "cannulation strategy", "cerebral perfusion", "type I aortic dissection" were conducted and analyzed. In addition, we looked at some new and very significant specific perfusion techniques such as anterograde cerebral perfusion combined with retrograde inferior vena caval perfusion (RIVP) and reperfusion via the right carotid artery before surgery. The arterial cannulation site and strategy should be determined individually. Monitoring measures are very necessary in the whole procedure.

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Right axillary and femoral artery perfusion with mild hypothermia for aortic arch replacement

Cited by 10 publications

References 23 publications

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

Retrograde Inferior Vena caval Perfusion for Total Aortic arch Replacement Surgery (RIVP-TARS): study protocol for a multicenter, randomized controlled trial

Cannulation strategies in type A aortic dissection: a novel insight narrative review

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