Abstract
The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality, and Cox regression hazard ratios were calculated to determine predictors of long-term mortality. Operative mortality was not influenced by cannulation site (16% for axillary cannulation vs. 19% for femoral cannulation, p = 0.64). In multivariate logistic regression analysis, hemodynamic instability (p < 0.001) and prolonged cardiopulmonary bypass time (>200 min; p = 0.05) emerged as independent predictors of operative mortality. Stroke rates were comparable between the two techniques (14% for axillary and 17% for femoral cannulation, p = 0.52). Five-year actuarial survival was comparable between the groups (55.1% for axillary and 65.7% for femoral cannulation, p = 0.36). In Cox regression analysis, predictors of long-term mortality were: age (p < 0.001), stroke (p < 0.001), prolonged cardiopulmonary bypass time (p = 0.001), hemodynamic instability (p = 0.002), and renal failure (p = 0.001). The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles.
Highlights
Acute Type A aortic dissection is a cardiovascular emergency with a risk of serious postoperative morbidities and death [1,2,3,4,5,6]
It has been hypothesized that cannulation of the femoral artery reverses flow in the thoracoabdominal aorta, which increases the risk of brain or organ malperfusion in those undergoing Type A aortic dissection repair [13, 16]
The axillary cannulation group was more likely to undergo repair in the modern surgical era compared to the femoral cannulation group (p < 0.001) and had a lower number of patients with instability compared to the femoral cannulation group (p = 0.009)
Summary
Acute Type A aortic dissection is a cardiovascular emergency with a risk of serious postoperative morbidities and death [1,2,3,4,5,6]. Improvements in surgical technique have led to decreases in operative mortality and adverse clinical outcomes in the modern era, which have been accompanied by a shift in cannulation site from the femoral artery to the axillary artery [1, 9, 10]. The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. Methods: A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Conclusions: The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles
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