Arterial Cannulation Strategy for Type A Aortic Dissection: A Network Meta-Analysis
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0059
Submission Type:
Abstract Submission
Authors:
Yujiro Yokoyama (1), Minami Watanabe (2), Tomohiro Fujisaki (3), Hisato Takagi (4), Toshiki Kuno (5), Shinichi Fukuhara (1)
Institutions:
(1) University of Michigan, Ann Arbor, MI, (2) Leigh Valley Health Network, Allentown, PA, (3) Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, NA, (4) Shizuoka Medical Center, Shizuoka, Shizuoka, (5) Montefiore Medical Center, Bronx, NY
Submitting Author:
Yujiro Yokoyama
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University of Michigan
University of Michigan
Co-Author(s):
Minami Watanabe
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Leigh Valley Health Network
Leigh Valley Health Network
Tomohiro Fujisaki
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Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
Hisato Takagi
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Shizuoka Medical Center
Shizuoka Medical Center
Toshiki Kuno
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Montefiore Medical Center
Montefiore Medical Center
Shinichi Fukuhara
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University of Michigan
University of Michigan
Presenting Author:
Yujiro Yokoyama
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St. Luke's University Health Network
St. Luke's University Health Network
Abstract:
OBJECTIVES: The optimal method for arterial cannulation in acute type A aortic dissection (TAAD) remains controversial. This study aimed to conduct a network meta-analysis to compare the clinical outcomes of the four most common cannulation strategies: single cannulation of the femoral artery (FA), axillary/subclavian artery (ASA), ascending aorta (AA), or dual arterial cannulation (DAC) with FA and ASA cannulations.
METHODS: Medline was searched in October 2023 to identify comparative studies reporting the clinical outcomes of different arterial cannulation strategies for TAAD. The outcomes of interest were perioperative mortality, stroke, spinal cord injury, reoperation for bleeding, renal failure requiring hemodialysis, and visceral malperfusion. Sensitivity analysis was conducted by limiting the studies with adjusted outcomes.
RESULTS: Overall, a total of 26 observational studies were identified, including 8,555 patients who underwent surgery for TAAD via AA (n =2,185), DAC (n =954), ASA (n=3425), and FA (n =1,991) cannulations. Propensity-score matching was used in 6 studies and inverse probability weighting in 2 studies. No adjustment methods were used in 18 studies. AA and ASA cannulations were associated with a significantly lower risk of perioperative mortality than FF cannulation (risk ratio [RR] [95% confidence interval [CI]] = 0.51 [0.38-0.69] and 0.69 [0.52-0.90], respectively). AA cannulation was also associated with a significantly reduced risk of reoperation for bleeding and renal failure requiring hemodialysis compared with ASA and FA cannulations. No significant differences in the rates of stroke, spinal cord injury, or visceral malperfusion were observed among the different cannulation strategies. Sensitivity analysis by limiting the studies with adjusted outcomes showed that AA cannulation was associated with decreased perioperative mortality compared to all other cannulation strategies (vs. DAC; RR [95% CI] =0.44 [0.25-0.78], vs. ASA; RR [95% CI] =0.44 [0.28-0.69], vs. FA; RR [95% CI] =0.40 [0.24-0.66]). Furthermore, ASA cannulation was associated with increased rates of spinal cord injury compared with all other cannulation strategies. The other outcomes of the sensitivity analysis were similar to the main outcomes.
CONCLUSIONS: The present network meta-analysis demonstrated that AA cannulation might be associated with favorable outcomes in terms of perioperative mortality and morbidity compared to other cannulation strategies.
METHODS: Medline was searched in October 2023 to identify comparative studies reporting the clinical outcomes of different arterial cannulation strategies for TAAD. The outcomes of interest were perioperative mortality, stroke, spinal cord injury, reoperation for bleeding, renal failure requiring hemodialysis, and visceral malperfusion. Sensitivity analysis was conducted by limiting the studies with adjusted outcomes.
RESULTS: Overall, a total of 26 observational studies were identified, including 8,555 patients who underwent surgery for TAAD via AA (n =2,185), DAC (n =954), ASA (n=3425), and FA (n =1,991) cannulations. Propensity-score matching was used in 6 studies and inverse probability weighting in 2 studies. No adjustment methods were used in 18 studies. AA and ASA cannulations were associated with a significantly lower risk of perioperative mortality than FF cannulation (risk ratio [RR] [95% confidence interval [CI]] = 0.51 [0.38-0.69] and 0.69 [0.52-0.90], respectively). AA cannulation was also associated with a significantly reduced risk of reoperation for bleeding and renal failure requiring hemodialysis compared with ASA and FA cannulations. No significant differences in the rates of stroke, spinal cord injury, or visceral malperfusion were observed among the different cannulation strategies. Sensitivity analysis by limiting the studies with adjusted outcomes showed that AA cannulation was associated with decreased perioperative mortality compared to all other cannulation strategies (vs. DAC; RR [95% CI] =0.44 [0.25-0.78], vs. ASA; RR [95% CI] =0.44 [0.28-0.69], vs. FA; RR [95% CI] =0.40 [0.24-0.66]). Furthermore, ASA cannulation was associated with increased rates of spinal cord injury compared with all other cannulation strategies. The other outcomes of the sensitivity analysis were similar to the main outcomes.
CONCLUSIONS: The present network meta-analysis demonstrated that AA cannulation might be associated with favorable outcomes in terms of perioperative mortality and morbidity compared to other cannulation strategies.
Aortic Symposium:
Dissection
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