Comparison of Femoral and Axillary Artery Cannulation in Acute Type A Aortic Dissection Surgery

Abstract

Introduction: One of the most important points of the acute type A aortic dissection surgery is how to perform cannulation regarding cerebral protection concerns and the conditions of arterial structures as a pathophysiological consequence of the disease.Objective: In this study, femoral and axillary cannulation methods were compared in acute type A aortic dissection operations.Methods: The study retrospectively evaluated 52 patients who underwent emergency surgery for acute type A aortic dissection. Patients without malperfusion according to Penn Aa classification were chosen for preoperative standardization of the study groups. The femoral arterial cannulation group was group 1 (n=22) and the axillary arterial cannulation group was group 2 (n=30). The groups were compared in terms of perioperative and postoperative results.Results: There was no statistically significant difference in terms of preoperative data. In terms of postoperative parameters, especially early mortality and new-onset cerebrovascular event, there was no statistically significant difference. Mortality rates in group 1 and group 2 were 13.6% (n=3) and 10% (n=3), respectively (P=0.685). Postoperative new-onset cerebral events ratio was found in 5 (22.7%) in the femoral cannulation group and 6 (20%) in the axillary cannulation group (P=0.812).Conclusion: Both femoral and axillary arterial cannulation methods can be safely performed in patients with acute type A aortic dissection, provided that cerebral protection strategies should be considered in the first place. The method to be performed may vary depending on the patient's current medical condition or the surgeon's preference.

Exploring Differences in Surgical Outcomes Depending on the Arterial Cannulation Strategy for Acute Type A Aortic Dissection: A Single-Center Study

“…Previous studies have found no significant difference in surgical time between antegrade and retrograde cannulation procedures [5,14]. However, the current study's operative results revealed that antegrade cannulation had significantly shorter operation times than retrograde cannulation.…”

“…Many studies have compared antegrade (axillary, innominate artery, or aortic) to retrograde cannulation [1- 5,12,13]. In this study, we used patient data to compare the 2 cannu- http://www.jchestsurg.org JCS lation methods and determine which approach would be preferable in a typical clinical situation rather than in any specific case.…”

“…This can occur when atherosclerosis or plaque is present in the aorta or when thrombus formation in the false lumen is washed out by the retrograde f low. Therefore, antegrade cannulation, which carries a lower risk of cerebral infarction, is increasingly preferred [1, 4,5,9,10,12,14]. In a meta-analysis comparing axillary and femoral cannulations, Hussain et al [14] noted that axillary cannulation was associated with a lower risk of stroke.…”

“…Type A aortic dissection (AD) and intramural hematoma (IMH) are critical medical conditions accompanied by severe pain; they typically result in death if left untreated [1][2][3][4][5][6][7]. Over time, the risk of rupture increases.…”

Predictive Factors of Mortality in Acute Aortic Dissection and Validity of the EuroSCORE Algorithm in a Small-Sized Cardiac Surgery Institution

“…This lower hematocrit could probably be explained by a lower body surface area in female patients and, therefore, greater hemodilution with the initiation of CPB. Similar to Gokalp et al [ 5 ] , the arterial cannulation approach was not a predictor of mortality.…”