Double arterial vs. single axillary cannulation in acute type A aortic dissections: a meta-analysis

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Acute type A aortic dissection (ATAAD) is a life-threatening condition requiring prompt surgical intervention.
• The choice of arterial cannulation strategy (single vs. double) impacts perioperative outcomes in ATAAD surgery.
• Understanding these effects is crucial for optimizing surgical decision-making and patient care.

Approach:

• A comprehensive meta-analysis was conducted using data from PubMed/MEDLINE, Scopus, and Cochrane databases up to August 23, 2023.
• Included studies focused on propensity score-matched cohorts to minimize confounding factors.
• Key early outcomes evaluated included operative mortality, postoperative stroke, re-exploration for bleeding, spinal cord injury, and renal replacement therapy.

Key Points:

• Analysis of 5 propensity score-matched studies involving 2127 patients revealed comparable operative mortality between double (axillary and femoral) and single (axillary) cannulation groups.
• Double cannulation was associated with significantly higher rates of postoperative stroke (OR: 1.69, 95% CI: 1.19-2.39).
• Patients undergoing double cannulation also showed an increased likelihood of requiring renal replacement therapy (OR: 1.35, 95% CI: 1.13-1.60).

Conclusions:

• Double arterial cannulation in ATAAD surgery is linked to an increased risk of postoperative stroke.
• The strategy of double cannulation also correlates with a higher incidence of requiring renal replacement therapy postoperatively.
• Single axillary cannulation may be associated with a potentially safer early outcome profile regarding these specific complications.