Carotid versus axillary artery cannulation for descending aorta remodeling in type A acute aortic dissection
作者机构：Department of Cardiac SurgerySichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengdu 610072Sichuan ProvinceChina Cardiac Surgery CenterSichuan Academy of Medical Sciences&Sichuan Provincial People’s HospitalChengdu 610072Sichuan ProvinceChina
出 版 物：《World Journal of Cardiology》 (世界心脏病学杂志（英文）)
年 卷 期：2024年第16卷第10期
页 面：564-573页
学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学]
基 金：Supported by Huanhua Talent for Discipline Backbone of Sichuan Provincial People’s Hospital,No.SY2022017 Science Fund for Distinguished Young Scholars of Sichuan Province,No.2021JDJQ0041 Sichuan Science and Technology Program,No.2020YFQ0060 National Natural Science and Technology Foundation of China,No.81800274
主 题：Acute type A aortic dissection Bilateral carotid arterial cannulation Descending aortic remodeling False lumen area ratio Prognosis
摘 要：BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)*** descending aorta remodeling is closely linked to the false lumen area ratio(FLAR),defined as false lumen area/aortic area,as well as to the incidence of renal replacement therapy(RRT).AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic *** A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the *** these,209 received right AA cannulation and 234 received bilateral CA *** primary outcome was the change in FLAR,as calculated from computed tomography angiography in three segments of the descending aorta:Thoracic(S1),upper abdominal(S2),and lower abdominal(S3).Secondary outcomes were the incidence of RRT and the serum inflammation response,as observed by the levels of high sensitivity C reaction protein(hs-CRP)and Interleukin-6(IL-6).RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group(S2:0.80±0.08 vs 0.75±0.07,P0.001;S3:0.57±0.12 vs 0.50±0.12,P0.001,respectively).The AA group also had a significantly higher incidence of RRT(19.1%vs 8.5%,P=0.001;odds ratio:2.533,95%CI:1.427-4.493)and higher levels of inflammation cytokines 24 h after the procedure[hr-CRP:117±17 vs 104±15 mg/L;IL-6:129(103,166)vs 83(69,101)pg/mL;both P0.001]compared to the CA *** The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation,as observed by a greater change in FLAR and lower incidence of RRT.
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