Abstract
The short-term results of subclavian artery cannulation (SC) for acute type-A dissection repair have been reported to be superior in regard to mortality and neurological outcomes when compared to femoral cannulation (FC). This study evaluates the long-term results of subclavian artery cannulation versus femoral cannulation for repair of acute type-A dissection with particular regard to neurological deficits, mortality and the need for re-operations. From 1992-2005, 346 patients underwent surgical repair of acute type-A dissection of which 290 patients survived the operation. SC was performed in 114 patients and FC in 176 patients. Follow-up (FU) was completed in 89.5% (n = 259) and the medium FU-period was 42 months (SC) and 69 months (FC). Endpoints were persistence of neurological-deficits, mortality, major complications and necessity for re-operations. Overall survival and disease-free survival at 5 years were significantly higher in the SC group (83% vs. 71%; p = 0.022 and 74% vs. 61%; p = 0.044). Freedom of re-operation also appeared to be higher in the SC group (89% vs. 79%; p = 0.125). During the follow-up period, 28 patients (11/114 vs. 17/176; p = 0.58) suffered from neurological deficits of which 16 patients had permanent neurological-deficits at the 5 year follow-up. Of these patients, significantly more belonged to the FC group indicating an improved neurological-outcome for the SC group (3/11 vs. 13/17; p = 0.019). This study demonstrates excellent long-term outcomes after emergency surgery for acute type-A dissection. Subclavian artery perfusion represents an excellent approach to repair acute type-A dissection. Beside a significantly reduced long-term mortality, this technique provides an improved neurological outcome and a higher disease-free survival-rate.
Highlights
Despite advances in more accurate diagnoses, improved prosthetic materials, better myocardial and cerebral protection, as well as increased surgical experience, surgery for acute type-A dissection remains an emergency intervention associated with high mortality rates and neurological complications [1, 2]
The short-term results of subclavian artery cannulation (SC) for acute type-A dissection repair have been reported to be superior in regard to mortality and neurological outcomes when compared to femoral cannulation (FC)
This study evaluates the long-term results of subclavian artery cannulation versus femoral cannulation for repair of acute type-A dissection with particular regard to neurological deficits, mortality and the need for re-operations
Summary
Despite advances in more accurate diagnoses, improved prosthetic materials, better myocardial and cerebral protection, as well as increased surgical experience, surgery for acute type-A dissection remains an emergency intervention associated with high mortality rates and neurological complications [1, 2]. Subclavian artery cannulation has been demonstrated to be a good alternative since it has two major advantages: SC allows antegrade perfusion of the central nervous system. This technique may be performed much easier and safer when compared to the more cumbersome approach of selective cannulation of the cerebral vessels. The purpose of this study was to assess the long-term results of subclavian artery cannulation versus femoral cannulation for repair of acute type-A dissection. The study aimed to elicit the long-term prevalence and outcomes of the persistence of neurological deficits, mortality and reoperations
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