A randomized trial comparing axillary versus innominate artery cannulation for aortic arch surgery
| Autor: | Mark D. Peterson, Vinay Garg, C. David Mazer, Michael W.A. Chu, John Bozinovski, François Dagenais, Roderick G.G. MacArthur, Maral Ouzounian, Adrian Quan, Peter Jüni, Deepak L. Bhatt, Thomas R. Marotta, Jeffrey Dickson, Hwee Teoh, Fei Zuo, Eric E. Smith, Subodh Verma, M. Nazir Khan, Feryal Saad, Muhammad Mamdani, David A. Latter, Thomas F. Floyd, Paul W.M. Fedak, Aditya Bharatha, Judith Hall, Danusha Nadamalavan, Mohammed Al-Omran, Ismail El-Hamamsy, Kevin E. Thorpe |
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| Rok vydání: | 2022 |
| Předmět: |
Pulmonary and Respiratory Medicine
Canada medicine.medical_specialty medicine.medical_treatment Aorta Thoracic 030204 cardiovascular system & hematology Catheterization law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Axillary artery Interquartile range law Modified Rankin Scale medicine.artery medicine Cardiopulmonary bypass Humans Stroke Brachiocephalic Trunk Aged Mechanical ventilation Cardiopulmonary Bypass business.industry Middle Aged medicine.disease Surgery Treatment Outcome 030228 respiratory system Cerebrovascular Circulation Deep hypothermic circulatory arrest Axillary Artery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 164:1426-1438.e2 |
| ISSN: | 0022-5223 |
| Popis: | Background Cerebral protection remains the cornerstone of successful aortic surgery; however, there is no consensus as to the optimal strategy. Objective To compare the safety and efficacy of innominate to axillary artery cannulation for delivering antegrade cerebral protection during proximal aortic arch surgery. Methods This randomized controlled trial (The Aortic Surgery Cerebral Protection Evaluation CardioLink-3 Trial, ClinicalTrials.gov Identifier: NCT02554032 ), conducted across 6 Canadian centers between January 2015 and June 2018, allocated 111 individuals to innominate or axillary artery cannulation. The primary safety outcome was neuroprotection per the appearance of new severe ischemic lesions on the postoperative diffusion-weighted-magnetic resonance imaging. The primary efficacy outcome was the difference in total operative time. Secondary outcomes included 30-day all-cause mortality and postoperative stroke. Results One hundred two individuals (mean age, 63 ± 11 years) were in the primary safety per-protocol analysis. Baseline characteristics between the groups were similar. New severe ischemic lesions occurred in 19 participants (38.8%) in the axillary versus 18 (34%) in the innominate group (P for noninferiority = .0009). Total operative times were comparable (median, 293 minutes; interquartile range, 222-411 minutes) for axillary versus (298 minutes; interquartile range, 231-368 minutes) for innominate (P for superiority = .47). Stroke/transient ischemic attack occurred in 4 (7.1%) participants in the axillary versus 2 (3.6%) in the innominate group (P = .43). Thirty-day mortality, seizures, delirium, and duration of mechanical ventilation were similar in both groups. Conclusions diffusion-weighted magnetic resonance imaging assessments indicate that antegrade cerebral protection with innominate cannulation is safe and affords similar neuroprotection to axillary cannulation during aortic surgery, although the burden of new neurological lesions is high in both groups. |
| Databáze: | OpenAIRE |
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