Aortic cannulation in complex aortic disease: playing or planning on fear

Amer Harky, Mohamad Bashir, Matthew Shaw, Callum Howard, Monira Sharif, Aung Oo
2019 Journal of Visualized Surgery  
The quest for the best strategy for arterial cannulation in the setting of complex proximal and arch aneurysm surgery remains elusive. Several cannulation strategies have been proposed to establish cardiopulmonary bypass (CPB) during aortic arch aneurysm surgery. Those strategies have direct influence on patients' post-operative outcomes. In current era of stringent evidence synthesis and with available monitoring tools for different organs and various methods for organ protection, it is
more » ... ction, it is imperative that a deliverable strategy for cannulation in complex proximal aortic aneurysm is employed. However, due to scarcity of robust evidence and in a climate where randomized control trials to establish comparative outcomes between central cannulation versus peripheral cannulation are difficult to set up, our understanding is very much limited to observational data and discretional experiences. In this review we aim to illustrate comprehensively the concrete evidence most suitable strategy for arterial cannulation in proximal and arch of the aorta pathology and drawing on the conflicting reports and their correlation to quality outcomes. Demographics Arch operations (n=150) Age at operation (years), mean [range] 66 [57, 73] Female gender, n (%) 65 (43.3) Body mass index (kg/m 2 ), mean [range] 27.8 [24.7, 30.6] Previous cardiac operation, n (%) 43 (28.7) Unstable angina, n (%) 9 (6.0) MI within 90 days of operation, n (%) 1 (0.7) NYHA class ≥ III, n (%) 28 (18.7) Current smoker, n (%) 12 (8.0) Diabetes, n (%) 13 (8.7) Hypercholesterolemia, n (%) 58 (38.7) Hypertension, n (%) 87 (58.0) Previous stroke, n (%) 8 (5.3) Respiratory disease, n (%) 21 (14.0) Peripheral vascular disease, n (%) 34 (22.7) Renal dysfunction, n (%) 9 (6.0) Left ventricular ejection fraction 30-50%, n (%) 18 (12.0) Left ventricular ejection fraction <30%, n (%) 4 (2.7) Logistic EuroSCORE, mean [range] 16.7 [9.4, 28.2] Table 3 Operative characteristics Characteristics Arch operations (n=150) Non-elective presentation, n (%) 45 (30.0) Pathology, n (%) Aneurysm 101 (67.3) Acute dissection 22 (14.7) Chronic dissection 14 (9.3) Other 4 (2.7) Pseudoaneurysm 4 (2.7) Bicuspid valve 2 (1.3) Coarctation 1 (0.7) Intramural haematoma 1 (0.7) Trauma 1 (0.7) Concomitant operation, n (%) CABG 25 (16.7) Valve 108 (72.0) Other cardiac 9 (6.0) Aortic segments, n (%) Root 91 (60.7) Ascending 126 (84.0) Hemi-arch 62 (41.3) Total arch 88 (58.7) Descending 9 (6.0) Thoraco-abdominal 1 (0.7) Conventional elephant truck, n (%) 23 (15.3) Frozen elephant truck, n (%) 15 (10.0) CPB time (mins), mean [range] 351 [275, 420] Aortic cross clamp time (mins), mean [range] 194 [138, 249] Circulatory arrest time (mins), mean [range] 46 [26, 88] CPB, cardiopulmonary bypass; CABG, coronary artery bypass grafting. Critical care LOS (days), mean [range] 2 [1, 4] 9 [4, 25] 5 [2, 19] 6.5 [5, 14] Hospital LOS (days), mean [range] 9.5 [7, 12.5] 15.5 [10, 28] 13 [9, 23] 17 [9, 24] CVA, cerebrovascular accident; LOS, length of stay.
doi:10.21037/jovs.2019.01.13 fatcat:uni2i4gaxbb2hkh5awu3ywv34q