Early outcomes after acute type A aortic dissection repair: Adequate perfusion, rather than cannulation strategy

The optimal arterial cannulation strategy for acute type A aortic dissection repair remains uncertain. We aimed to evaluate the association between cannulation strategy and early postoperative outcomes and to identify perioperative factors associated with adverse events.

A single-center, retrospective cohort study was conducted at West China Hospital, Sichuan University, between January 2019 and June 2024, including consecutive patients undergoing repair of acute type A aortic dissection. Primary outcomes were in-hospital death and postoperative neurologic complications. Multivariable logistic regression and propensity-score matching were used to evaluate associations with early outcomes.

Among 866 patients, femoral, axillary, and combined femoral + axillary cannulation were used in 694 (80.1%), 144 (16.6%), and 28 (3.2%) patients, respectively. Patients in the axillary and combined groups more frequently had primary arch tears and underwent more extensive arch repair. In-hospital death occurred in 43 (5.0%) patients and postoperative neurologic complications in 113 (13.0%) patients, with comparable rates across groups; paraplegia was more frequent in the combined group (2/28 [7.1%]; P = .03). In multivariable analysis, axillary cannulation was not independently associated with in-hospital death (odds ratio, 1.74; 95% confidence interval, 0.69-4.03), postoperative neurologic complications (odds ratio, 0.73; 95% confidence interval, 0.37-1.34), or cerebral infarction (odds ratio, 1.05; 95% confidence interval, 0.51-2.01). Preoperative shock (odds ratio, 3.20; 95% confidence interval, 1.44-6.91) and higher peak intraoperative lactate (odds ratio, 1.22; 95% confidence interval, 1.14-1.30) were independently associated with in-hospital death. In 142 propensity score-matched femoral-axillary pairs, mortality and neurologic complication rates remained similar.

Cannulation strategy was not independently associated with in-hospital death or postoperative neurologic complications. Preoperative shock and higher peak intraoperative lactate were more consistently associated with adverse early outcomes, supporting the clinical importance of timely systemic reperfusion and effective cerebral protection.