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Updated: Jul 15, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Ascending aortic versus axillary artery cannulation in Stanford type A aortic dissection repair: a propensity
Yutian Sun1, Hao Chen2, Xiangyou Sun1
1Department of Cardiovascular Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
Background:
Axillary artery cannulation is widely regarded as the preferred arterial inflow strategy for surgical repair of Stanford type A aortic dissection (TAAD). Ascending aortic cannulation has emerged as a practical alternative, yet comparative evidence on early outcomes and long-term survival remains limited. This study aimed to compare the early outcomes and long-term prognosis between these two arterial cannulation strategies.
Methods:
We retrospectively analyzed 160 patients who underwent surgery for TAAD at a single center between February 2017 and January 2025. Of these, 64 patients received axillary artery cannulation and 96 underwent ascending aortic cannulation. Early postoperative outcomes and long-term survival were assessed using inverse probability of treatment weighting (IPTW) and Kaplan-Meier survival curves.
Results:
Before adjustment, 30-day mortality was higher in the axillary than the ascending aortic cannulation group (9.4% vs. 1.0%, P=0.02). After IPTW, mortality remained numerically higher with axillary cannulation but did not reach statistical significance (10.7% vs. 2.9%, P=0.19). After weighting, axillary cannulation was associated with longer operation time (P=0.03), cardiopulmonary bypass (CPB) time (P=0.001), and aortic cross-clamp time (P<0.001). Axillary cannulation was associated with longer mechanical ventilation and intensive care unit (ICU) stay and higher rates of postoperative cerebral infarction and acute kidney injury (AKI) both before and after IPTW, while reintubation was numerically higher after weighting without reaching statistical significance (P=0.08). Unweighted Kaplan-Meier analysis favored ascending aortic cannulation (P=0.04), whereas the difference was attenuated after IPTW (P=0.11).
Conclusions:
In this single-center propensity score-weighted cohort, ascending aortic cannulation was associated with lower short-term mortality and fewer postoperative complications compared with axillary cannulation. Mortality and long-term survival differences favored ascending aortic cannulation numerically but were attenuated after IPTW, underscoring the need for larger prospective studies to confirm these findings.