Amer Harky1, Jeffrey Sk Chan2, Christiana Bithas1, Alexander Hof3, Monira Sharif4, Saied Froghi5, Mohamad Bashir6. 1. Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom of Great Britain and Northern Ireland. 2. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Region of the People's Republic of China. 3. Department of Cardiovascular Surgery, Heinrich-Heine-University, Medical Faculty, Dusseldrof, Germany. 4. School of Medicine, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland. 5. Department of Surgery, Imperial College NHS Trust, Hammersmith Hospital, Du Cane Rd London, United Kingdom of Great Britain and Northern Ireland. 6. Manchester Royal Infirmary, United Kingdom of Great Britain and Northern Ireland.
Abstract
OBJECTIVE: To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. METHODS: A 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. RESULTS: Only 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. CONCLUSION: There 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.
OBJECTIVE: To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. METHODS: A 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. RESULTS: Only 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. CONCLUSION: There 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.
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