The Optimal Cannulation Strategy for Acute Type A Aortic Dissection Aortic Repair: Aortic Versus Axillary

The purpose of this study was to assess the safety and efficacy of aortic cannulation in comparison with right axillary artery (RAX) cannulation.

Between 2018 and 2023, 267 and 364 patients underwent aortic or axillary cannulation for aortic repair for acute type A aortic dissection (ATAAD), respectively. Clinical features and outcomes were compared after inverse probability of treatment weighting was stabilized.

In the original cohort, patients in the aortic group had higher incidences of innominate artery (IA) dissection (59.6% vs. 45.1%, p<0.001), RAX dissection (13.9% vs. 4.7%, p<0.001), and right common carotid artery (RCCA) dissection (42.7% vs. 13.7%, p<0.001). After weighting, baseline characteristics were well balanced, resulting in a pseudo-cohort of aortic (n=265) vs. RAX (n=357) patients. Aortic cannulation was associated with a lower rate of cannulation-related complications (0.4% vs. 3.5%, p=0.011). In-hospital mortality (8.3% vs. 6.1%, p=0.346) and stroke rates (4.1% vs. 5.8%, p=0.383) were comparable between groups. The aortic group experienced lower rates of reoperation for bleeding (8.0% vs. 2.3%, p=0.001) and extracorporeal membrane oxygenation use (5.0% vs. 2.0%, p=0.046). Mid-term survival did not differ significantly before (p=0.849) or after weight stabilization (p=0.345).

Direct aortic cannulation in ATAAD provides in-hospital and mid-term outcomes that are not statistically different from those with axillary cannulation. Aortic cannulation offers an alternative to axillary cannulation, especially for patients with IA/RAX/RCCA dissection.