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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.
Insights
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.
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.
Background:
Cannulation strategy in acute type A dissection (ATAD) varies widely without known gold standards. This study compared ATAD outcomes of axillary vs femoral artery cannulation in a large cohort from the International Registry of Acute Aortic Dissection (IRAD).
Methods:
The study retrospectively reviewed 2145 patients from the IRAD Interventional Cohort (1996-2021) who underwent ATAD repair with axillary or femoral cannulation (axillary group: n = 1106 [52%]; femoral group: n = 1039 [48%]). End points included the following: early mortality; neurologic, respiratory, and renal complications; malperfusion; and tamponade. All outcomes are presented as axillary with respect to femoral.
Results:
The proportion of patients younger than 70 years in both groups was similar (n = 1577 [74%]), as were bicuspid aortic valve, Marfan syndrome, and previous dissection. Patients with femoral cannulation had slightly more aortic insufficiency (408 [55%] vs 429 [60%]; P = .058) and coronary involvement (48 [8%] vs 70 [13%]; P = .022]. Patients with axillary cannulation underwent more total aortic arch (156 [15%] vs 106 [11%]; P = .02) and valve-sparing root replacements (220 [22%] vs 112 [12%]; P < .001). More patients with femoral cannulation underwent commissural resuspension (269 [30.9%] vs 324 [35.3%]; P = .05). Valve replacement rates were not different. The mean duration of cardiopulmonary bypass was longer in the femoral group (190 [149-237] minutes vs 196 [159-247] minutes; P = .037). In-hospital mortality was similar between the axillary (n = 165 [15%]) and femoral (n = 149 [14%]) groups (P = .7). Furthermore, there were no differences in stroke, visceral ischemia, tamponade, respiratory insufficiency, coma, or spinal cord ischemia.
Conclusions:
Axillary cannulation is associated with a more stable ATAD presentation, but it is a more extensive intervention compared with femoral cannulation. Both procedures have equivalent early mortality, stroke, tamponade, and malperfusion outcomes after statistical adjustment.
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