Outcome after aortic, axillary, or femoral cannulation for acute type A aortic dissection

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 158; no. 1; pp. 27 - 34.e9
• Main Authors: Kreibich, Maximilian, Chen, Zehang, Rylski, Bartosz, Bavaria, Joseph E., Brown, Chase R., Branchetti, Emanuela, Vallabhajosyula, Prashanth, Szeto, Wilson Y., Desai, Nimesh D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2019
• Subjects: Aneurysm, Dissecting - surgery; Aorta; Aortic Aneurysm - surgery; ascending aorta; Axillary Artery; cannulation; Catheterization, Central Venous - methods; Catheterization, Central Venous - mortality; Catheterization, Central Venous - statistics & numerical data; central cannulation; Female; Femoral Artery; Humans; Male; Middle Aged; Operative Time; Retrospective Studies; Treatment Outcome; type A aortic dissection; CT; type A aortic dissection; central cannulation; CPB; TEE; HCA; ADA; RCP; cannulation; ascending aorta
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2018.11.100

The optimal method for arterial cannulation in acute aortic dissection type A (ADA) remains controversial. The aim of this study was to compare central ascending aortic, axillary, and femoral cannulation in patients who underwent surgery for acute ADA. Between 2006 and 2017, 584 patients were operated on for acute ADA. Of those, 355 (61%) underwent ascending aortic, 101 (17%) right axillary, and 128 (22%) femoral cannulation for arterial inflow. Clinical features and outcomes were compared after inverse probability weighting. After inverse probability weighting there were no statistical differences in preoperative characteristics. Operative details differed significantly among the 3 groups: hemiarch replacement was performed more often in the central aortic and the femoral group (P < .001), whereas total arch replacement was performed more often in the axillary group (P < .001). Cardiopulmonary bypass (P = .022) and aortic cross-clamp (P = .021) times were shortest in the aortic cannulation group and longest in the femoral cannulation group. Postoperative morbidities were similar; procedure-related stroke (P = .783) and the need for renal replacement therapy (P = .446). In-hospital mortality (P = .680) and long-term survival were similar (log rank, P = .704). Multilevel multivariate mixed effect logistic regression showed that the cannulation strategy was not associated with in-hospital mortality. Central ascending aortic cannulation in patients with ADA can be used as safely as axillary or femoral cannulation, providing another option for quick and easy establishment of cardiopulmonary bypass.