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

作　　者：Qin Jiang Tao Yu Ke-Li Huang Ke Liu Xi Li Sheng-Shou Hu 

机构地区：[1]Department of Cardiac Surgery,Sichuan Provincial People’s Hospital,University of Electronic Science and Technology of China,Chengdu 610072,Sichuan Province,China [2]Cardiac Surgery Center,Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital,Chengdu 610072,Sichuan Province,China

出　　处：《World Journal of Cardiology》2024年第10期564-573,共10页世界心脏病学杂志（英文）

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.

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)cannulation.Postoperative 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 remodeling.METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study.Of these,209 received right AA cannulation and 234 received bilateral CA cannulation.The 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,P<0.001;S3:0.57±0.12 vs 0.50±0.12,P<0.001,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 P<0.001]compared to the CA group.CONCLUSION 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 

分 类 号：R654.3[医药卫生—外科学]