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Axillary vs Femoral Arterial Cannulation in Acute Type A Dissection: International Multicenter Data.

Malak Elbatarny1, Santi Trimarchi2, Amit Korach3

  • 1Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

The Annals of Thoracic Surgery
|March 8, 2024
PubMed
Summary

Axillary cannulation offers stable acute type A dissection (ATAD) presentation but is more invasive. Both axillary and femoral cannulation strategies show similar early mortality and complication rates in ATAD repair.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • Cannulation strategies for acute type A dissection (ATAD) lack standardized protocols.
  • This study investigates the comparative outcomes of axillary versus femoral artery cannulation in ATAD repair.

Purpose of the Study:

  • To compare the efficacy and safety of axillary versus femoral artery cannulation in patients undergoing acute type A dissection repair.
  • To identify potential differences in early mortality and major complications between the two cannulation strategies.

Main Methods:

  • Retrospective analysis of 2145 patients from the International Registry of Acute Aortic Dissection (IRAD) cohort (1996-2021).
  • Comparison of outcomes between axillary (n=1106) and femoral (n=1039) cannulation groups.
  • Evaluation of endpoints including early mortality, neurologic, respiratory, renal complications, malperfusion, and tamponade.

Main Results:

  • No significant difference in in-hospital mortality (15% axillary vs. 14% femoral).
  • Similar rates of stroke, visceral ischemia, tamponade, respiratory insufficiency, coma, and spinal cord ischemia between groups.
  • Axillary cannulation was associated with more total aortic arch procedures and valve-sparing root replacements.

Conclusions:

  • Axillary cannulation may be preferred for more stable ATAD presentations, though it involves a more extensive procedure.
  • Both axillary and femoral cannulation demonstrate comparable early mortality and major complication rates in ATAD repair after statistical adjustment.