Search

Background The choice of an optimal cannulation site for aortic repair in patients with Stanford A acute aortic dissection remains controversial. The aim of this study was to compare the early results and long-term outcomes of axillar and direct aortic cannulation. Methods A total of 235 consecutive patients who underwent surgical aortic repair with the use of axillar or direct aortic cannulation from January 2006 to April 2015 were analyzed. The primary end points were long-term overall cumulative survival and freedom from major cerebrovascular events with up to 10 years of follow-up. The secondary end points were early postoperative clinical characteristics and rates of adverse events. To control for confounders, a 1:3 propensity score matching was performed. Results After matching, there were no statistically significant differences between the two groups regarding baseline characteristics. Both groups were associated with comparable outcomes; among other things, the length of stay in the intensive care unit (ICU) ( p = 0.220), mechanical ventilation ( p = 0.177), total hospital stay ( p = 0.243), and hospital rates of adverse events. There were no statistically significant differences ( p = 0.625) in terms of freedom from major cerebrovascular events. However, both early ( p = 0.009) and late ( p = 0.016) overall survival were significantly poorer for patients undergoing aortic cannulation. Conclusions The outcomes were comparable regarding early hospital outcomes and rates of adverse events. Whereas postoperative freedom from major cerebrovascular events was similar, survival over long-term follow-up was significantly poorer when direct aortic cannulation was used. More investigations are needed to enable an understanding of the underlying factors for potentially higher late mortality when direct aortic cannulation is used during a surgical procedure for acute Stanford A dissection. [ABSTRACT FROM AUTHOR]

Aortic crossclamp may increase the risk for acute aortic dissection and embolic stroke in patients with severe aortic calcification. Additionally, in CABG re-operation aortic crossclamp may necessitate extensive dissection of fibrous adhesions which may intensify the potential risk of injury to the aorta, pulmonary artery or patent bypass grafts. Therefore, it appears to be advantageous in patients undergoing re-do CABG or with aortic calcification to minimize surgical manipulation of the aorta by abandonment of aortic crossclamp. Adequate myocardial protection and convenient surgical exposure without aortic crossclamp max be achieved by intraaortic administration of the short acting ß-blocker esmolol. [Copyright &y& Elsevier]