Outcome with peripheral versus central cannulation in acute Type A dissection †.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Acute aortic dissection type A (AADA) is a life-threatening emergency requiring prompt surgical intervention.
• Cannulation for cardiopulmonary bypass is critical, with femoral and central approaches having distinct implications.
• Femoral cannulation, while accessible, may increase risks of plaque rupture and embolism due to aortic backflow.

Purpose of the Study:

• To compare the outcomes of initial femoral versus central arterial cannulation in patients undergoing surgery for AADA.
• To determine if cannulation strategy impacts morbidity and mortality in AADA patients.

Main Methods:

• A retrospective analysis of 177 patients with AADA operated between 2003 and 2012.
• Patients were categorized based on initial arterial cannulation: central aortic vessels or femoral artery.
• Demographic data, operative parameters (bypass time, cross-clamp time, circulatory arrest time, lowest temperature), and postoperative outcomes were evaluated.

Main Results:

• No significant differences were observed in bypass, cross-clamp, or circulatory arrest times between central (94 patients) and femoral (83 patients) cannulation groups.
• Postoperative cerebral infarction rates (13% vs. 9%) and 30-day mortality (20% vs. 17%) were comparable.
• The need for postoperative dialysis was borderline higher in the femoral cannulation group (40% vs. 28%).

Conclusions:

• This single-center study suggests that both central and femoral cannulation are viable strategies for AADA surgery, yielding similar early results.
• The patient's preoperative clinical and hemodynamic status, not the cannulation technique, appears to be the primary driver of early mortality risk.
• Further research may be warranted to explore long-term outcomes and refine cannulation strategies.