Which cannulation (ascending aortic cannulation or peripheral arterial cannulation) is better for acute type A aortic dissection surgery?

Publisher: Oxford University Press Country of Publication: England NLM ID: 101158399 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1569-9285 (Electronic) Linking ISSN: 15699285 NLM ISO Abbreviation: Interact Cardiovasc Thorac Surg Subsets: MEDLINE

Publication: 2012-2022 : Oxford, England : Oxford University Press
Original Publication: Amsterdam, The Netherlands ; New York : Elsevier Science, c2002-

Aorta*; Aortic Dissection/*surgery ; Aortic Aneurysm, Thoracic/*surgery ; Catheterization/*methods; Acute Disease ; Aortic Dissection/diagnostic imaging ; Aortic Dissection/mortality ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/mortality ; Blood Vessel Prosthesis Implantation/methods ; Blood Vessel Prosthesis Implantation/mortality ; Catheterization/adverse effects ; Catheterization, Peripheral/adverse effects ; Catheterization, Peripheral/methods ; Evidence-Based Medicine ; Female ; Humans ; Male ; Postoperative Complications/diagnosis ; Postoperative Complications/mortality ; Prognosis ; Radiography ; Risk Assessment ; Survival Analysis ; Treatment Outcome

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Which cannulation (ascending aortic cannulation or peripheral arterial cannulation) is better for acute type A aortic dissection surgery?' Altogether 393 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Femoral artery cannulation has the highest rate of mortality, stroke rate and other complications including retrograde cerebral embolization, organ malperfusion and perfusion of the false lumen. Five out of 14 papers were found to be reporting in favour of axillary (or subclavian) artery cannulation over femoral artery cannulation. In a total of 1829 patients evaluated in these studies, 1068 patients demonstrated a significantly lower complication rate with axillary artery cannulation than femoral artery cannulation. Some of the larger studies showed femoral artery cannulation has higher mortality and stroke rates ranging from 6.5% to 40% and 3% to 17%, respectively. Meanwhile, mortality and stroke rates were ranging from 3% to 8.6% and 1.75% to 4%, respectively, in the favour of axillary artery cannulation. A total of seven studies evaluated direct aortic cannulation for the establishment of cardiopulmonary bypass (CPB). They demonstrated mortality and stroke rates from 0% to 15% and 3.8% to 21%, respectively. Central cannulation has promising results with a lower mortality rate but a higher stroke rate. Direct cannulation of the true lumen is a promising method for quick and easy establishment of CPB. Axillary artery cannulation with a side graft, although it takes more time to construct, is proven to be safe and straightforward, with fewer local and systemic complications including lower mortality and neurological complications.
(2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.)

15

Comment in: Interact Cardiovasc Thorac Surg. 2010 May;10(5):802. (PMID: 20403991)

Date Created: 20100216 Date Completed: 20100811 Latest Revision: 20221207

20240829

10.1510/icvts.2009.230409

20154346