Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2024; 16(10): 564-573
Published online Oct 26, 2024. doi: 10.4330/wjc.v16.i10.564
Carotid versus axillary artery cannulation for descending aorta remodeling in type A acute aortic dissection
Qin Jiang, Tao Yu, Ke-Li Huang, Ke Liu, Xi Li, Sheng-Shou Hu
Qin Jiang, Tao Yu, Ke Liu, Xi Li, Department of Cardiac Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan Province, China
Ke-Li Huang, Cardiac Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
Sheng-Shou Hu, Department of Cardiac Surgery, Fuwai Hospital, Beijing 100037, China
Author contributions: Jiang Q, Huang KL, and Hu SS designed the research study; Yu T, Liu K, and Li X preformed the research; all authors analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript
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; and National Natural Science and Technology Foundation of China, No. 81800274.
Institutional review board statement: The study was reviewed and approved by Sichuan Provincial People’s Hospital Institutional Review Board (No. 2021-215).
Informed consent statement: The study was reviewed and approved by Sichuan Provincial People’s Hospital Institutional Review Board, and patient’s informed consent was waived due to the retrospective nature of this study.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at jq349@163.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qin Jiang, MD, PhD, Doctor, Senior Researcher, Senior Scientist, Surgeon, Department of Cardiac Surgery, Sichuan Provincial People’s Hospital, No. 32 West Second Section First Ring Road, Chengdu 610072, Sichuan Province, China. jq349@163.com
Received: March 8, 2024
Revised: September 3, 2024
Accepted: September 27, 2024
Published online: October 26, 2024
Processing time: 223 Days and 2 Hours
Abstract
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.

Keywords: Acute type A aortic dissection; Bilateral carotid arterial cannulation; Descending aortic remodeling; False lumen area ratio; Prognosis

Core Tip: Arterial cannulation sites for the surgical repair of type A acute aortic dissection have gradually evolved from right axillary artery cannulation to bilateral carotid artery cannulation based on femoral artery cannulation. This retrospective observational study found the carotid artery cannulation strategy was associated with better postoperative abdominal aorta remodeling with a higher false lumen area ratio, a lower incidence of renal replacement therapy, and lower levels of inflammation cytokines compared with the axillary artery cannulation mode.