Which cannulation (ascending aortic cannulation or peripheral arterial cannulation) is better for acute type A aortic dissection surgery?

Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Which cannulation (ascending aortic cannulation or peripheral arterial cannulation) is better for acute type A aortic dissection surgery?' Altogether 393 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Femoral artery cannulation has the highest rate of mortality, stroke rate and other complications including retrograde cerebral embolization, organ malperfusion and perfusion of the false lumen. Five out of 14 papers were found to be reporting in favour of axillary (or subclavian) artery cannulation over femoral artery cannulation. In a total of 1829 patients evaluated in these studies, 1068 patients demonstrated a significantly lower complication rate with axillary artery cannulation than femoral artery cannulation. Some of the larger studies showed femoral artery cannulation has higher mortality and stroke rates ranging from 6.5% to 40% and 3% to 17%, respectively. Meanwhile, mortality and stroke rates were ranging from 3% to 8.6% and 1.75% to 4%, respectively, in the favour of axillary artery cannulation. A total of seven studies evaluated direct aortic cannulation for the establishment of cardiopulmonary bypass (CPB). They demonstrated mortality and stroke rates from 0% to 15% and 3.8% to 21%, respectively. Central cannulation has promising results with a lower mortality rate but a higher stroke rate. Direct cannulation of the true lumen is a promising method for quick and easy establishment of CPB. Axillary artery cannulation with a side graft, although it takes more time to construct, is proven to be safe and straightforward, with fewer local and systemic complications including lower mortality and neurological complications.

The effect of postoperative malperfusion after surgical treatment of type A acute aortic dissection on early and mid-term survival

“…If a center is only able to perform a limited repair technique, but still saves the life of the patient, then the primary intention of the procedure has been achieved. [24,25] In this study, no independent predictors of renal and mesenteric PM were identified. However, using univariate analyses, having a LVEF value less than 40% was statistically relevant (P < 0.0001).…”

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

“…Our data show, that femoral cannulation was performed more often in a sicker patient group measured by the ASA classification. However, the ASA classification (15). In addition, the study from Kamiya et al could only show a borderline significance with aortic in contrast to femoral cannulation regarding 30-day-mortality, despite higher ASA classification in the femoral cannulation group (13).…”

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

“…While Lee et al reported that there was no significant difference in the incidence of cerebral complications between right axillary arterial perfusion and femoral arterial perfusion, 84) there are a number of reports on the superiority of the former. 43,85,86) The right axillary artery is mostly used 87,88) and also utilized for antegrade cerebral perfusion during circulatory arrest. Kano et al have used left axillary arterial perfusion with fairly good results, 89) although a small sized artery may cause an inadequate perfusion rate in some cases.…”