P079. Choice of Arch Branch Vessel Cannulation in Acute Type A Aortic Dissection Surgery
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Louisville School of Medicine
Louisville, KY
United States - Contact Me
Juliana is a third-year medical student at the University of Louisville. She holds a Masters degree from East Carolina University in Molecular Biology and Biotechnology and plans to apply to general surgery programs in the 2024-25 Match cycle. Juliana is currently involved in multiple research projects with the University of Louisville's Cardiovascular and Thoracic Surgery Department and hope to continue with similar endeavors throughout her career.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objectives
The mortality rate of patients with an untreated acute type A aortic dissection (ATAAD) is 1-2% per hour for the first 24-48 hours. Various aortic cannulation strategies for ATAAD surgery have been described in literature, with the principle of each strategy being safe and expeditious cannulation of the true lumen. We review our experience with aortic arch branch vessel cannulation (axillary vs innominate artery) to assess operative outcomes.
Methods
From January 2016 to January 2022, all patients who underwent surgery for ATAAD at our institution were included (N=106). These patients were divided into 2 groups: axillary artery cannulation (N=65, 61%) and innominate artery cannulation (N=41, 39%). Baseline characteristics and outcomes of both groups were compared. Categorical variables were compared using Chi square testing. Continuous variable comparison was conducted using Wilcoxon signed-rank test.
Results
The baseline patient characteristics were identical in both groups and are described in Table 1. The reason for selecting one artery over the other for initial cannulation during ATAAD included the extent of dissection, surgeon preference, and hemodynamic instability. No difference in time on cardiopulmonary bypass was observed between the axillary artery group and the innominate artery group (213 minutes vs 198 minutes, P=0.08), nor was there a change in cross clamp times (123 minutes vs 105 minutes, P=0.2). Similar percentages of both groups underwent circulatory arrest (89% vs 92%, P=0.55) with antegrade cerebral perfusion (95% vs 84%, P=0.08). The operative mortality was also consistent across both groups (12% axillary vs 10% innominate, P=0.71). Other post-operative complications such as stroke (11% vs 10%, P=0.86), bleeding (15% vs 5%, P=0.09), renal failure (26% vs 12%, P=0.08) and prolonged ventilation (61% vs 49%, P=0.19) were similar across the groups.
Conclusions
Both axillary and innominate artery as options for initial cannulation in ATAAD surgery are safe and effective strategies and can be used in the appropriate clinical setting. No difference was noted in operative metrics, including time on CBP and cross-clamp time. Similarly, patient outcomes did not differ based on axillary vs innominate artery cannulation.
Authors
Juliana Cobb (1), Priyadarshini Chandrashekhar (1), Erin Schumer (2), Michele Gallo (2), Mark Slaughter (3), Brian Ganzel (2), Jaimin Trivedi (2), Siddharth Pahwa (2)
Institutions
(1) University of Louisville School of Medicine, Louisville, KY, (2) University of Louisville, Louisville, KY, (3) University of Louisville/Jewish Hospital, Louisville, KY
The mortality rate of patients with an untreated acute type A aortic dissection (ATAAD) is 1-2% per hour for the first 24-48 hours. Various aortic cannulation strategies for ATAAD surgery have been described in literature, with the principle of each strategy being safe and expeditious cannulation of the true lumen. We review our experience with aortic arch branch vessel cannulation (axillary vs innominate artery) to assess operative outcomes.
Methods
From January 2016 to January 2022, all patients who underwent surgery for ATAAD at our institution were included (N=106). These patients were divided into 2 groups: axillary artery cannulation (N=65, 61%) and innominate artery cannulation (N=41, 39%). Baseline characteristics and outcomes of both groups were compared. Categorical variables were compared using Chi square testing. Continuous variable comparison was conducted using Wilcoxon signed-rank test.
Results
The baseline patient characteristics were identical in both groups and are described in Table 1. The reason for selecting one artery over the other for initial cannulation during ATAAD included the extent of dissection, surgeon preference, and hemodynamic instability. No difference in time on cardiopulmonary bypass was observed between the axillary artery group and the innominate artery group (213 minutes vs 198 minutes, P=0.08), nor was there a change in cross clamp times (123 minutes vs 105 minutes, P=0.2). Similar percentages of both groups underwent circulatory arrest (89% vs 92%, P=0.55) with antegrade cerebral perfusion (95% vs 84%, P=0.08). The operative mortality was also consistent across both groups (12% axillary vs 10% innominate, P=0.71). Other post-operative complications such as stroke (11% vs 10%, P=0.86), bleeding (15% vs 5%, P=0.09), renal failure (26% vs 12%, P=0.08) and prolonged ventilation (61% vs 49%, P=0.19) were similar across the groups.
Conclusions
Both axillary and innominate artery as options for initial cannulation in ATAAD surgery are safe and effective strategies and can be used in the appropriate clinical setting. No difference was noted in operative metrics, including time on CBP and cross-clamp time. Similarly, patient outcomes did not differ based on axillary vs innominate artery cannulation.
Authors
Juliana Cobb (1), Priyadarshini Chandrashekhar (1), Erin Schumer (2), Michele Gallo (2), Mark Slaughter (3), Brian Ganzel (2), Jaimin Trivedi (2), Siddharth Pahwa (2)
Institutions
(1) University of Louisville School of Medicine, Louisville, KY, (2) University of Louisville, Louisville, KY, (3) University of Louisville/Jewish Hospital, Louisville, KY
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.