Premium
The long‐term impact of peripheral cannulation for redo cardiac surgery
Author(s) -
Brown James A.,
Kilic Arman,
ArandaMichel Edgar,
SernaGallegos Derek,
Habertheuer Andreas,
Bianco Valentino,
Thoma Floyd W.,
Navid Forozan,
Sultan Ibrahim
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14852
Subject(s) - medicine , cardiac surgery , cardiopulmonary bypass , peripheral , surgery , proportional hazards model , hazard ratio , sepsis , stroke (engine) , adverse effect , dialysis , anesthesia , confidence interval , mechanical engineering , engineering
Background Redo cardiac surgery carries an inherent risk for adverse short‐term outcomes and worse long‐term survival. Strategies to mitigate these risks have been numerous, including initiation of cardiopulmonary bypass via peripheral cannulation before resternotomy. This study evaluated the impact of central versus peripheral cannulation on long‐term survival after redo cardiac surgery. Methods This was an observational study of open cardiac surgeries between 2010 and 2018. Patients undergoing open cardiac surgery that utilized cardiopulmonary bypass, who also had more than equal to 1 prior cardiac surgery, were identified. Kaplan‐Meier survival estimation and multivariable Cox regression analysis were performed to assess the impact of peripheral cannulation on survival. To isolate long‐term survival, patients with operative mortality were excluded and survival time was counted from the date of discharge until the date of death. Results Of the 1660 patients with more than equal to 1 prior cardiac surgery, 91 (5.5%) received peripheral cannulation. After excluding patients with operative mortality and after multivariable risk‐adjustment, the peripheral cannulation group had significantly increased hazard of death, as compared to the central cannulation group (HR 1.53, 95% CI: 1.01, 2.30, P = .044). Yet, there were no relevant differences for other postoperative outcomes, including blood product requirement, prolonged ventilation (>24 hours), pneumonia, reoperation for bleeding, stroke, sepsis, and new dialysis requirement. Conclusions This is the first study reporting the long‐term impact of peripheral cannulation for redo cardiac surgery after excluding patients with operative mortality. These data suggest that central cannulation may to be the preferred approach to redo cardiac surgery whenever safe and possible.