Femoral artery cannulation as a safe alternative for aortic dissection arch repair in the era of axillary artery cannulation

Abstract

Background: To evaluate the safety and efficacy of femoral artery cannulation as an alternative to axillary artery cannulation, we retrospectively compared outcomes between patients with axillary or femoral artery cannulation during open aortic arch repair for type A aortic dissection (TAAD). Methods: Between January 2014 and January 2019, 646 patients underwent open aortic arch repair with circulatory arrest for TAAD using antegrade selective cerebral perfusion (SACP) and were divided into two groups according to the site of arterial cannulation: an axillary artery group (axillary group, n=558) or a femoral artery group (femoral group, n=88). The axillary artery was considered as the primary cannulation site, and the femoral artery was used as an alternative when axillary artery cannulation was deemed unsuitable or had failed. Propensity score matching was performed to correct baseline differences.Results: After propensity score matching, the patients' characteristics were comparable between groups (n=85 in each). The incidence of in-hospital mortality (10.6% vs. 14.1%; P=0.642) and stroke (3.5% vs. 5.9%; P=0.720) were comparable between the axillary and femoral groups. The incidence of newly required dialysis was lower in the femoral group, but the difference was not statistically significant (34.1% vs. 20.0%; P=0.050). Other outcomes and major adverse events were comparable. Conclusions: Femoral artery cannulation produced similar perioperative outcomes to axillary cannulation after open arch repair for TAAD. The femoral artery can be used as a safe and effective alternative to the axillary artery for arterial cannulation in TAAD patients undergoing open arch repair.

Does the weekend effect exist for acute type A aortic dissection?—a retrospective case-control study

“…The surgical strategies have been reported in detail previously ( 8 , 9 ). Briefly, the standard procedure in our center for ATAAD included total arch replacement with a tetrafurcate graft and frozen elephant trunk (FET).…”

Role of transesophageal echocardiography in surgical treatment of aortic dissection

“…Another significant event at this stage is false lumen perfusion, where perfused blood predominantly enters the false lumen through a reentry, causing aortic-type malperfusion due to increased pressure in the false lumen. Although there is an ongoing debate about the best perfusion strategy to prevent false lumen perfusion [37][38][39][40], the author believes there is no single "best" strategy as situations vary in individual cases. The optimal approach is to "perfuse first and modify it as needed according to the result" [41].…”

Does arterial cannulation site for aortic dissection repair impact surgical outcomes?

“…Such a change may result in inadequate flow distribution leading to life-threatening conditions. The aorta is a conduit that extends from the left ventricle that delivers pulsatile blood distally to organs and distal tissues ( 12 ). Access to the aorta via arterial cannulation is critical to establishing cardiopulmonary bypass.…”