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Carotid versus axillary artery cannulation for descending aorta remodeling in type A acute aortic dissection

World Journal of Cardiology 2024年第10期16卷 564-573页

作者： Qin Jiang Tao Yu Ke-Li Huang Ke Liu Xi Li Sheng-Shou Hu Department of Cardiac Surgery Sichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengdu 610072Sichuan ProvinceChina Cardiac Surgery Center Sichuan Academy of Medical Sciences&Sichuan Provincial People’s HospitalChengdu 610072Sichuan ProvinceChina

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,Pratio: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 P<0.001]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.

关键词： Acute type A aortic dissection Bilateral carotid arterial cannulation Descending aortic remodeling false lumen area ratio Prognosis

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