Is Axillary Better Than Femoral Artery Cannulation in Repair of Acute Type A Aortic Dissection?
| Autor: | Alexander Kogan, Yoav Krupik, Ehud Raanani, Alexander Lipey, Ami Shinfeld, Yael Peled, Eilon Ram, Leonid Sternik |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Femoral artery 030204 cardiovascular system & hematology Arterial cannulation Catheterization 03 medical and health sciences Postoperative Complications 0302 clinical medicine Axillary artery medicine.artery Catheterization Peripheral Humans Medicine Renal Insufficiency Mortality Type a dissection Aged Retrospective Studies Aortic dissection business.industry General Medicine Middle Aged medicine.disease Surgery Femoral Artery Stroke Survival Rate Aortic Dissection 030228 respiratory system Acute type Axillary Artery Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 14:124-133 |
| ISSN: | 1559-0879 1556-9845 |
| DOI: | 10.1177/1556984519836879 |
| Popis: | Objective We compared early and late outcomes of patients who underwent femoral versus axillary artery cannulation for repair of acute type A aortic dissection. Methods Between 2004 and 2017, we retrospectively evaluated the clinical outcomes of 135 consecutive patients who underwent emergency surgery for acute type A aortic dissection repair. Patients were divided into 2 groups: those who underwent femoral ( n = 84) and those who underwent right axillary ( n = 51) artery cannulation. Mean patient age was 63 ± 13 years and 88 (65%) were male. Results Overall operative mortality was 12.6% (axillary 15.7%, femoral 10.7%; P = 0.564). Patients who underwent axillary compared to femoral artery cannulation had a statistically nonsignificant higher operative mortality rate among both stable and unstable patients (13% vs. 6.5%, P = 0.405 and 40% vs. 22.7%, P = 0.818, respectively). While there was no difference in major complication rates, such as stroke, low cardiac output, and surgical revision for bleeding/tamponade, there was a higher incidence of renal failure that required dialysis in patients who underwent axillary cannulation (12% vs. 1%, P = 0.022). Multivariate analysis demonstrated that predictors for the composite endpoint of operative mortality or severe organ malperfusion, such as renal failure or cerebrovascular accident, were hemodynamic instability on admission (OR 3.87; 95% CI, 1.23 to 12.63; P = 0.021), lower preoperative creatinine clearance (OR 0.94; 95% CI, 0.90 to 0.97; P < 0.001); and the use of axillary artery cannulation (OR 4.1; 95% CI, 1.43 to 12.78; P = 0.011). Among those discharged from hospital, the 3-year survival rate was 91% in the axillary group and 87% in the femoral group ( P = 0.772). Conclusions Based on our experience, emergent surgery for both stable and unstable patients with acute type A aortic dissection demonstrated similar survival rates and significantly less renal impairment when using the femoral cannulation approach. |
| Databáze: | OpenAIRE |
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