Application of ascending aorta cannulation and brachiocephalic trunk cannulation in acute type A aortic dissection: A propensity-score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUN Kexiong , ZHANG Li , GAO Xia , CUI Cong , ZHANG Xianghui , XIAO Changbo , ZHANG Yafei , WU Gang ,  WANG Pingfan

The Eighth Ward of Cardiovascular Surgery, Henan Province Chest Hospital, Zhengzhou, 450003, P.R.China;

Corresponding author：

WANG Pingfan, Email: xinyuskx@126.com

Keywords：

Acute type A aortic dissection; artery cannulation; cardiopulmonary bypass; propensity-score matching; surgery

DOI：

10.7507/1007-4848.202005035

Video：

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Objective To investigate the application of ascending aorta cannulation and brachiocephalic trunk cannulation in acute type A aortic dissection.Methods We screened 183 patients with acute type A aortic dissection from January 2017 to January 2020 in our hospital. They were divided into 2 groups according to the cannulation strategy: ascending aorta cannulation and brachiocephalic trunk cannulation (a DAC group, n=42, 33 males and 9 females with a median age of 50 years) and the single axillary artery cannulation (an AAC group, n=141, 116 males and 25 females with a median age of 51 years). The general clinical data, intraoperative data and early postoperative results of the two groups before and after matching with propensity scores were compared.Results Before propensity-score matching, the operation time, cardiopulmonary bypass time, aortic occlusion time and ICU stay in the DAC group were all shorter than those in the AAC group (P<0.05). The early postoperative mortality, and rates of brain complications, renal failure and pulmonary complications in the DAC group were significantly lower than those in the AAC group. After propensity-score matching, the operation time in the DAC group was significantly shorter than that in the AAC group (P<0.05). The early postoperative mortality, and rates of brain complications and pulmonary complications in the DAC group were significantly lower than those in the AAC group.Conclusion Ascending aorta cannulation and brachiocephalic trunk cannulation can provide a safe, fast and effective method of establishing cardiopulmonary bypass for some acute type A aortic dissection patients, and significantly shorten the operation time without increasing surgical complications.

Citation： SUN Kexiong, ZHANG Li, GAO Xia, CUI Cong, ZHANG Xianghui, XIAO Changbo, ZHANG Yafei, WU Gang, WANG Pingfan. Application of ascending aorta cannulation and brachiocephalic trunk cannulation in acute type A aortic dissection: A propensity-score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(3): 325-330. doi: 10.7507/1007-4848.202005035 Copy

1.	Inoue Y, Minatoya K, Oda T, et al. Surgical outcomes for acute type A aortic dissection with aggressive primary entry resection. Eur J Cardiothorac Surg, 2016, 50(3): 567-573.
2.	Kusadokoro S, Kimura N, Hori D, et al. Utility of double arterial cannulation for surgical repair of acute type A dissection. Eur J Cardiothorac Surg, 2020, 57(6): 1068-1075.
3.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
4.	Reece TB, Tribble CG, Smith RL, et al. Central cannulation is safe in acute aortic dissection repair. J Thorac Cardiovasc Surg, 2007, 133(2): 428-434.
5.	Kreibich M, Chen Z, Rylski B, et al. Outcome after aortic, axillary, or femoral cannulation for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2019, 158(1): 27-34.
6.	Jormalainen M, Raivio P, Mustonen C, et al. Direct aortic versus peripheral arterial cannulation in surgery for type A aortic dissection. Ann Thorac Surg, 2020, 110(4): 1251-1258.
7.	Kimura N, Ohnuma T, Itoh S, et al. Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection. Am J Cardiol, 2014, 113(4): 724-730.
8.	Yang B, Norton EL, Rosati CM, et al. Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience. J Thorac Cardiovasc Surg, 2019, 158(3): 675-687.
9.	Yu PJ, Cassiere HA, Kohn N, et al. Utility of established risk models to predict surgical mortality in acute type-A aortic dissection. J Cardiothorac Vasc Anesth, 2016, 30(1): 39-43.
10.	Rosinski BF, Idrees JJ, Roselli EE, et al. Cannulation strategies in acute type A dissection repair: A systematic axillary artery approach. J Thorac Cardiovasc Surg, 2019, 158(3): 647-659.
11.	Lin CY, Tseng CN, Lee HA, et al. Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience. PLoS One, 2019, 14(2): e211900.
12.	Moeller E, Nores M, Stamou SC. Repair of acute type-A aortic dissection in the present era: Outcomes and controversies. Aorta (Stamford), 2019, 7(6): 155-162.
13.	Neri E, Massetti M, Capannini G, et al. Axillary artery cannulation in type A aortic dissection operations. J Thorac Cardiovasc Surg, 1999, 118(2): 324-329.
14.	Hillebrand J, Zheng Z, Ploss A, et al. Axillary artery cannulation provides balanced cerebral oxygenation. Heart Vessels, 2016, 31(7): 1077-1083.
15.	Lijoi A, Scarano F, Dottori V, et al. Stanford type A aortic dissection. A new surgical approach. Tex Heart Inst J, 1998, 25(1): 65-67.
16.	Frederick JR, Yang E, Trubelja A, et al. Ascending aortic cannulation in acute type A dissection repair. Ann Thorac Surg, 2013, 95(5): 1808-1811.
17.	Minatoya K, Karck M, Szpakowski E, et al. Ascending aortic cannulation for Stanford type A acute aortic dissection: another option. J Thorac Cardiovasc Surg, 2003, 125(4): 952-953.
18.	Venturini A, Gallingani A, Asta A, et al. Performing antegrade selective cerebral perfusion using the AV cannula: A novel approach. Aorta (Stamford), 2019, 7(6): 181-184.
19.	Abe T, Usui A. The cannulation strategy in surgery for acute type A dissection. Gen Thorac Cardiovasc Surg, 2017, 65(1): 1-9.

1. Inoue Y, Minatoya K, Oda T, et al. Surgical outcomes for acute type A aortic dissection with aggressive primary entry resection. Eur J Cardiothorac Surg, 2016, 50(3): 567-573.
2. Kusadokoro S, Kimura N, Hori D, et al. Utility of double arterial cannulation for surgical repair of acute type A dissection. Eur J Cardiothorac Surg, 2020, 57(6): 1068-1075.
3. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
4. Reece TB, Tribble CG, Smith RL, et al. Central cannulation is safe in acute aortic dissection repair. J Thorac Cardiovasc Surg, 2007, 133(2): 428-434.
5. Kreibich M, Chen Z, Rylski B, et al. Outcome after aortic, axillary, or femoral cannulation for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2019, 158(1): 27-34.
6. Jormalainen M, Raivio P, Mustonen C, et al. Direct aortic versus peripheral arterial cannulation in surgery for type A aortic dissection. Ann Thorac Surg, 2020, 110(4): 1251-1258.
7. Kimura N, Ohnuma T, Itoh S, et al. Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection. Am J Cardiol, 2014, 113(4): 724-730.
8. Yang B, Norton EL, Rosati CM, et al. Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience. J Thorac Cardiovasc Surg, 2019, 158(3): 675-687.
9. Yu PJ, Cassiere HA, Kohn N, et al. Utility of established risk models to predict surgical mortality in acute type-A aortic dissection. J Cardiothorac Vasc Anesth, 2016, 30(1): 39-43.
10. Rosinski BF, Idrees JJ, Roselli EE, et al. Cannulation strategies in acute type A dissection repair: A systematic axillary artery approach. J Thorac Cardiovasc Surg, 2019, 158(3): 647-659.
11. Lin CY, Tseng CN, Lee HA, et al. Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience. PLoS One, 2019, 14(2): e211900.
12. Moeller E, Nores M, Stamou SC. Repair of acute type-A aortic dissection in the present era: Outcomes and controversies. Aorta (Stamford), 2019, 7(6): 155-162.
13. Neri E, Massetti M, Capannini G, et al. Axillary artery cannulation in type A aortic dissection operations. J Thorac Cardiovasc Surg, 1999, 118(2): 324-329.
14. Hillebrand J, Zheng Z, Ploss A, et al. Axillary artery cannulation provides balanced cerebral oxygenation. Heart Vessels, 2016, 31(7): 1077-1083.
15. Lijoi A, Scarano F, Dottori V, et al. Stanford type A aortic dissection. A new surgical approach. Tex Heart Inst J, 1998, 25(1): 65-67.
16. Frederick JR, Yang E, Trubelja A, et al. Ascending aortic cannulation in acute type A dissection repair. Ann Thorac Surg, 2013, 95(5): 1808-1811.
17. Minatoya K, Karck M, Szpakowski E, et al. Ascending aortic cannulation for Stanford type A acute aortic dissection: another option. J Thorac Cardiovasc Surg, 2003, 125(4): 952-953.
18. Venturini A, Gallingani A, Asta A, et al. Performing antegrade selective cerebral perfusion using the AV cannula: A novel approach. Aorta (Stamford), 2019, 7(6): 181-184.
19. Abe T, Usui A. The cannulation strategy in surgery for acute type A dissection. Gen Thorac Cardiovasc Surg, 2017, 65(1): 1-9.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of ascending aorta cannulation and brachiocephalic trunk cannulation in acute type A aortic dissection: A propensity-score matching study

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