Innominate vs. Axillary Artery Cannulation in Aortic Surgery: a Systematic Review and Meta-Analysis.

Amer Harky,Jeffrey Sk Chan,Saied Froghi,Alexander Hof,Monira Sharif,Christiana Bithas,Mohamad Bashir

doi:10.21470/1678-9741-2018-0272

Abstract

ObjectiveTo investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery.MethodsA comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017.ResultsOnly three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups.ConclusionThere is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site.

Highlights

Thoracic aortic surgery entails complex and major procedures performed in specialized centres by dedicated aortic surgeons
Di Eusanio et al.[3], among others, have shown that selecting an ideal arterial cannulation site can have a favourable impact on reducing neurological complications and lower mortality rates in patient with acute type A aortic dissections
Electronic database searches and screening were performed by two reviewers independently using PubMed, Ovid, Scopus, and Excerpta Medica database (EMBASE) to identify all randomized and nonrandomized controlled trials up to March 2017 that compared axillary to innominate artery (IA) cannulation in thoracic aortic surgery

Summary

Introduction

Thoracic aortic surgery entails complex and major procedures performed in specialized centres by dedicated aortic surgeons. Such procedures are associated with significant morbidity and mortality rates. Di Eusanio et al.[3], among others, have shown that selecting an ideal arterial cannulation site can have a favourable impact on reducing neurological complications and lower mortality rates in patient with acute type A aortic dissections. Regardless of cerebral perfusion and temperature management, neurological injuries are the highest risk complications during aortic arch surgery[1]. To minimize such complications during aortic arch surgery, deep hypothermic circulatory arrest (DHCA) with antegrade cerebral perfusion (ACP) is most widely used[1]. Aside from ACP, retrograde cerebral perfusion (RCP) is feasible and established in conjunction with DHCA

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