Aortic Cannulation Research Articles

Abstract 17063: Pericardial Patch Augmentation of the Anterior and Posterior Tricuspid Leaflets Relieves Leaflet Tethering and Improves Coaptation in an Acute Porcine Model

Background: Tricuspid annuloplasty is generally effective in treating functional tricuspid regurgitation (TR), but patients with severe annular dilation or leaflet tethering have a high risk of recurrence. Hypothesis: We hypothesized that anterior and posterior patch augmentation (APA) of the tricuspid valve (TV) would reduce leaflet tethering, improve coaptation, and effectively treat TR. Methods: We evaluated APA repair in an acute porcine model. The TV was accessed via a right thoracotomy and cardiopulmonary bypass (CPB) was initiated with bicaval venous and ascending aortic cannulation. The anterior and posterior TV leaflets were separated from the annulus, and a 1.5 cm wide partial reverse frustum-shaped pericardial patch was implanted. 3D transepicardial echocardiography was used to image the TV pre- and post-implantation. Geometric measurements were assessed using Tomtec and compared with paired t-tests. Results: APA repair was performed in five pigs (weight 60-80 kg). All animals were weaned from CPB in sinus rhythm. TR was trace or absent in all cases after APA repair. There were no changes in pressure gradient (0.5 vs 0.5, p>0.9) or annular area (11.2 vs 10.1 cm 2 , p=0.19). APA repair was associated with a decreased tenting height and angle of the anterior (height: 9.0 vs 4.6 mm, p=0.03; angle: 20.9° vs 16.1°, p=0.04) and posterior (height: 9.8 vs 5.5 mm, p=0.03; angle: 28.1° vs 21.8°, p=0.03) leaflets. Central coaptation length increased in all leaflets (septal: 3.8 vs 6.6 mm, p=0.04, anterior: 4.7 vs 12.7 mm, p<0.01, posterior: 4.5 vs 13.2 mm, p<0.01). Conclusions: APA repair was feasible, safe, reduced leaflet tenting, and improved coaptation. This novel repair method shows promise for patients with severe annular dilation or leaflet tethering who otherwise have a high risk of recurrence with annuloplasty alone. Furthermore, by avoiding suture placement near the conduction system, it may reduce the risk of post-operative conduction abnormalities.

Late Survival After Redo Mitral Operation With Minithoracotomy Compared With Sternotomy

BackgroundThe long-term effectiveness of minithoracotomy over redo median sternotomy for reoperative mitral operation is not well described. Here we present long-term survival after reoperative mitral operation based on operative approach. MethodsAdults undergoing mitral valve operation with previous sternotomy by redo sternotomy and minithoracotomy were reviewed from our prospectively maintained institutional database from 1997 to 2022. Propensity score matching was performed to compare short- and long-term outcomes. ResultsOf 750 consecutive patients, thoracotomy was performed in 503 (67%). Median follow-up was 5.0 years (interquartile range, 0-23 years). Intraoperatively, sternotomy patients were more likely to have central aortic cannulation (205 of 223 [93%] vs 265 of 481 [56%]), cardioplegic arrest (220 of 223 [99%] vs 124 of 481 [26%]), and mitral valve replacement (190 of 223 [85%] vs 358 of 481 [74%]). Thoracotomy patients were older (63 ± 13 vs 58 ± 14 years) with elective presentation (387 of 503 [77%] vs 128 of 247 [52%]). Sternotomy patients were more likely to have endocarditis (52 of 247 [21%] vs 45 of 503 [9%], P < .001). At 10 years, thoracotomy patients experienced improved survival (52% ± 3% vs 46% ± 4%, P = .004). After propensity matching, 10-year survival was significantly higher for thoracotomy patients compared with sternotomy patients (60% ± 5% vs 42% ± 5%, P = .0006). The greatest difference in survival was at the first 6 months after operation (96% ± 1% vs 81% ± 3%, P < .001). ConclusionsFor patients undergoing reoperative mitral valve operation, minimally invasive right anterior thoracotomy can significantly decrease risk of death in the first 6 months, with durable survival benefit out to 10 years. We present a large single-center series to suggest an important opportunity to durably improve outcomes after reoperative mitral operation through wider use of right minithoracotomy.

Anesthetic considerations in supravalvular aortic stenosis: A case series

Supravalvular aortic stenosis (SVAS), characterized by elastin arteriopathy, presents either as a localized narrowing at the sinotubular junction or as a diffuse form with additional involvement of the ascending aorta, aortic arch, and its branches. Associated lesions of the aortic valve, coronary artery narrowing, and pulmonary artery stenosis can further complicate the disease process. These patients are inherently at risk for developing myocardial ischemia, particularly in the setting of anesthesia or sedation. The left ventricular hypertrophy, secondary to the obstruction, results in increased left ventricular wall tension and myocardial oxygen consumption. Associated anatomic factors in the coronary arteries can further impair coronary blood flow. Any anesthetic drug that further increases oxygen consumption or decreases the coronary blood flow will result in an imbalance and increase the risk of cardiac arrest. We present a series of three patients with SVAS who were operated at our institute and subsequently discharged with good outcomes. The hemodynamic goal during the perioperative should aim to balance the myocardial oxygen supply-demand ratio. Extreme vigilance and aggressive resuscitative measures are needed to prevent any adverse myocardial event that can happen immediately after anesthetic induction or during periods of intense sympathetic stimulation such as laryngoscopy, sternotomy, aortic cannulation, or during emergence from anesthesia.

Natural history of the distal aorta following elective root replacement in patients with Marfan syndrome

ObjectiveIt is unclear if the addition of a prophylactic arch operation is beneficial at the time of root replacement in patients with Marfan syndrome (MFS). This project aims to understand the fate of the distal aorta following elective root replacement in patients with MFS. MethodsBetween 2000 and 2019, 124 adult patients with MFS were identified as having undergone elective aortic root replacement with a clamped distal aortic anastomosis during their lifetime. Serial axial imaging was analyzed. The primary outcome was a composite of subsequent type B aortic dissection (TBAD), aneurysmal degeneration (>4 cm), and aortic reintervention. Secondary outcomes included subsequent TBAD and mortality. ResultsMean age at root replacement was 33.3 years. Median follow-up was 11.3 years. Thirty-one patients (25%) experienced the primary outcome, with no survival difference (P = .9). The crossclamp and aortic cannulation sites were stable (growth rate, 0.33 mm/year), and 2 patients (1.6%) required reintervention there. Twenty-three patients (19.8%) experienced subsequent TBAD. Patients with TBAD had a higher rate of distal degeneration (P < .001), but no significant change in survival (P = .2). Preoperative hypertension (odds ratio, 3.96; P < .05) and younger age at root replacement (odds ratio, 1.05; P < .05) increased the risk of TBAD, based on regression analysis. ConclusionsThe distal aorta (including the clamp and cannulation site) overall appears stable in patients with MFS following elective root replacement without prophylactic arch operation. Development of TBAD seems to be the primary driver of distal degeneration. Factors associated with TBAD development included hypertension, underscoring the importance of strict blood pressure control in these patients.

Direct Aortic Versus Supra-Aortic Arterial Cannulation During Surgery for Acute Type A Aortic Dissection.

In this study we evaluated the impact of direct aortic cannulation versus innominate/subclavian/axillary artery cannulation on the outcome after surgery for type A aortic dissection. The outcomes of patients included in a multicenter European registry (ERTAAD) who underwent surgery for acute type A aortic dissection with direct aortic cannulation versus those with innominate/subclavian/axillary artery cannulation, i.e. supra-aortic arterial cannulation, were compared using propensity score matched analysis. Out of 3902 consecutive patients included in the registry, 2478 (63.5%) patients were eligible for this analysis. Direct aortic cannulation was performed in 627 (25.3%) patients, while supra-aortic arterial cannulation in 1851 (74.7%) patients. Propensity score matching yielded 614 pairs of patients. Among them, patients who underwent surgery for TAAD with direct aortic cannulation had significantly decreased in-hospital mortality (12.7% vs. 18.1%, p = 0.009) compared to those who had supra-aortic arterial cannulation. Furthermore, direct aortic cannulation was associated with decreased postoperative rates of paraparesis/paraplegia (2.0 vs. 6.0%, p < 0.0001), mesenteric ischemia (1.8 vs. 5.1%, p = 0.002), sepsis (7.0 vs. 14.2%, p < 0.0001), heart failure (11.2 vs. 15.2%, p = 0.043), and major lower limb amputation (0 vs. 1.0%, p = 0.031). Direct aortic cannulation showed a trend toward decreased risk of postoperative dialysis (10.1 vs. 13.7%, p = 0.051). This multicenter cohort study showed that direct aortic cannulation compared to supra-aortic arterial cannulation is associated with a significant reduction of the risk of in-hospital mortality after surgery for acute type A aortic dissection. ClinicalTrials.gov Identifier: NCT04831073.

Minimally invasive cardiac surgery in low-resource settings: right vertical infra-axillary mini-thoracotomy without peripheral cannulation - the first 100 cases.

Literature is scarce on minimally invasive cardiac surgery in adults with a right vertical infra-axillary thoracotomy approach without using peripheral cannulation. This study aimed to analyze the perioperative, early outcomes of minimally invasive cardiac surgery with direct vision using central aortic-venous cannulation through a right vertical infra-axillary thoracotomy, vs. standard cardiac surgery with median sternotomy. This retrospective study included the first 100 adult patients who were operated on via right vertical infra-axillary thoracotomy and central aortic and venous cannulation. The control group comprised 100 adult patients who underwent cardiac surgery through a median sternotomy and central aortic and venous cannulation. The thoracotomy group was associated with prolonged aortic cross-clamp time, cardiopulmonary bypass time, and operation time. The amount of postoperative chest tube drainage and blood transfusion was higher in the sternotomy group. No difference was found between the groups in terms of postoperative morbidity and mortality rates. Despite a higher level of pain in the thoracotomy group on the first 3 postoperative days, patient satisfaction was higher in this group. In a resource-limited setting, minimally invasive cardiac surgery with direct vision using central aortic-venous cannulation through a right vertical infra-axillary thoracotomy may help to establish minimally invasive cardiac surgery with better cosmetic results, and higher patient satisfaction compared to the median sternotomy approach. Outcomes during the learning curve were similar.

P25: Assessment of VentriFlo True Pulse Pump in Cardiopulmonary Bypass Circuit In vivo

Objective: The objective of this study was to evaluate the hemodynamic and laboratory data during the post-cardiopulmonary bypass (CPB) phase in vivo in cardiovascular surgery utilizing the VentriFlo True Pulse Pump, a novel pulsatile extracorporeal blood pump capable of generating a natural-like pulse through standard oxygenators, cannulas, and tubing sets. Methods: The surgical procedure in porcine animal model (n=2, weight 26 and 23 kg) consisted of full median sternotomy access, central aortic cannulation, transatrial venous cannula insertion under general anesthesia. The intended duration of 3 hours has been maintained. In one case, a roller pump (RP) has been instituted. Second case has received the VentriFlo pulsatile pump (VentriFlo Inc., Pelham, NH). Hemodynamics were recorded during the CPB support period and for 3 hours post-CPB, and blood sampling was performed every hour. Results: The aortic pulse pressure was consistently higher with the VentriFlo pump compared to the RP (47 mm Hg vs. 25 mm Hg) (Figure 1). Although the pump flow during CPB was comparable (Both approximately 1.3 L/min), cardiac output was higher in the VentriFlo pig during the post-CPB period (1-3 hours) compared to the RP pig (2.2 L/min vs. 1.1 L/min). Regarding blood tests, the RP group exhibited a higher white blood cell count (21,800/uL vs. 13,150/uL in the VentriFlo pig). Conclusion: The VentriFlo pulsatile pump demonstrated the capability to deliver and maintain normal pulsatile flow and optimal cardiac output during and after CPB. More studies will be necessary to elucidate longer duration postoperative outcomes in cardiovascular surgical setup.Figure 1. Left – Aortic pulse pressure during the study. Middle – cardiac output post CPB. Right – WBC, white blood cell count. CPB, cardiopulmonary bypass.

A Single-Centre Experience With Direct True Lumen Aortic Cannulation in Acute Type-A Aortic Dissection Surgery: Fast, Effective, and Safe

Direct true lumen cannulation of the aorta (DTLC) enables effective antegrade perfusion and is a potentially advantageous technique for cardiopulmonary bypass (CPB) in acute Type-A aortic dissection (ATAAD) scenarios. This report presents results with this cannulation technique.

Direct open aortic cannulation under temporary retrograde cerebral flush perfusion in acute aortic dissection Stanford type A—a case report

Direct open aortic cannulation under temporary retrograde cerebral flush perfusion in acute aortic dissection Stanford type A—a case report

(618) Successful Aortic Arch Cannulation and Perfusion of a Heart Donated after Circulatory Death

(618) Successful Aortic Arch Cannulation and Perfusion of a Heart Donated after Circulatory Death

Central aortic versus axillary artery cannulation for aortic arch surgery

ObjectiveCentral aortic cannulation for aortic arch surgery has become more popular over the last decade; however, evidence comparing it with axillary artery cannulation remains equivocal. This study compares outcomes of patients who underwent axillary artery and central aortic cannulation for cardiopulmonary bypass during arch surgery. MethodsA retrospective review of 764 patients who underwent aortic arch surgery at our institution between 2005 and 2020 was performed. The primary outcome was failure to achieve uneventful recovery, defined as having experienced at least 1 of the following: in-hospital mortality, stroke, transient ischemic attack, bleeding requiring reoperation, prolonged ventilation, renal failure, mediastinitis, surgical site infection, and pacemaker or implantable cardiac defibrillator implantation. Propensity score matching was used to account for baseline differences across groups. A subgroup analysis of patients undergoing surgery for aneurysmal disease was performed. ResultsBefore matching, the aorta group had more urgent or emergency operations (P = .039), fewer root replacements (P < .001), and more aortic valve replacements (P < .001). After successful matching, there was no difference between the axillary and aorta groups in failure to achieve uneventful recovery, 33% versus 35% (P = .766), in-hospital mortality, 5.3% versus 5.3% (P = 1), or stroke, 8.3% versus 5.3% (P = .264). There were more surgical site infections in the axillary group, 4.8% versus 0.4% (P = .008). Similar results were seen in the aneurysm cohort with no differences in postoperative outcomes between groups. ConclusionsAortic cannulation has a safety profile similar to that of axillary arterial cannulation in aortic arch surgery.

Ascending aorta cannulation for isolated liver procurement in extended criteria donors: a safe option in case of massive infrarenal aortic atherosclerosis.

The chronic organ shortage and the increased number of patients on the waiting list for liver transplantation have led to a progressive increase in the use of extended criteria donors. Nowadays more and more overweight donors with several comorbidities are selected for donation providing acceptable patient and liver graft survival. These donors have often aortic atherosclerosis which can spare the hepatic artery making suitable the liver for procurement. Massive aortic atherosclerosis localized to infrarenal aorta can challenge aortic cannulation for organ cooling. We herein describe in a stepwise approach the aortic cannulation realized at the ascending aorta level in case of massive infrarenal aortic atherosclerosis in ECD donors. This technique represents a safe option when abdominal aorta is not suitable for cannulation and it should be included into the surgical armamentarium of liver transplant surgeon.

Surgical correction and postoperative period management of a patient with the giant left atrium: case report

This case report describes the history of a 62-year-old man with symptoms of severe heart failure caused by critical mitral valve (MV) &amp;nbsp;stenosis with extremely enlarged left atrium (LA) and chronic rheumatic heart disease. The patient has had MV replacement, aortic valve (AoV) replacement, tricuspid valve (TV) plastic surgery, left atrial thrombectomy, reduction, and resection of the LA.&lt;br /&gt; The operation was performed by median sternotomy, in condition of artificial blood circulation with aortic cannulation, separate cannulation of Cava veins and hypothermia up to 29 C. Selective antegrade cold blood cardioplegia was used for the myocardium protection.&lt;br /&gt; Revision of the MV was performed via the right atrium. Findings: the valves deformed by severe fibrosis, thickened subvalvular structures. Also, there was a massive thrombosis of the LA cavity. A thrombectomy was performed, total amount of evacuated thrombotic masses - 350 ml. Considering the circumstances of atriomegalia, was decided to provide reduction of the LA. MV replacement with mechanical prosthesis SJM MastersSeries # 31, aortic valve replacement with prosthesis SJM MastersSeries #25, and Suture commissuroannuloplasty were performed.&lt;br /&gt; We believe that our surgical tactics has effectively reduced the size of the LA, together with the correction of valvular malformation, can significantly improve the patient's life quality.

Patient-Specific Computational Modeling of Different Cannulation Strategies for Extracorporeal Membrane Oxygenation.

Institution of extracorporeal membrane oxygenation (ECMO) results in unique blood flow characteristics to the end-organ vascular beds. We studied the interplay between cardiac-driven and extracorporeal membrane oxygenation (ECMO)-driven flow to vascular beds in different ECMO configurations using a patient-specific computational fluid dynamics (CFD) analysis. A computational ECMO model (femoral artery cannulation [FAC]) was constructed using patient-specific imaging and hemodynamic data. Following model calibration, we augmented the 3D geometrical model to represent alternative ECMO configurations (ascending aorta cannulation [AAC] and subclavian artery cannulation [SAC]). We performed CFD analyses, including a novel virtual color-dye analysis to compare global and regional blood flow and pressure characteristics as well as contributions of cardiac and ECMO-derived flow to the various vascular beds. Flow waveforms at all the aortic branch vessels were pulsatile, despite low cardiac output and predominant nonpulsatile ECMO-driven hemodynamics. Virtual color-dye analysis revealed differential contribution of cardiac and ECMO-derived flow to the end-organ vascular beds in the FAC model, while this was more evenly distributed in the AAC and SAC models. While global hemodynamics were relatively similar between various ECMO configurations, several distinct hemodynamic indices, in particular wall shear stress and oscillatory shear patterns, as well as differential contribution of ECMO-derived flow to various vascular beds, showed remarkable differences. The clinical impact of this study highlighting the relevance of CFD modeling in assessment of complex hemodynamics in ECMO warrants further evaluation.

Creatine phosphate preconditioning reduces ischemiareperfusion injury in isolated rat heart

Aim . To study the effect of simultaneous administration of creatine phosphate immediately before ischemia on cardiodynamic parameters and biomarkers of oxidative stress in the coronary venous blood flow during retrograde perfusion in an isolated rat heart. Materials and methods . 20 Wistar albino rats were divided into 2 groups: group 1 (control) and group 2 (experimental), 10 rats per group. Cannulation and retrograde perfusion of aorta of an isolated rat heart with Krebs–Henseleit buffered solution by Landendorff was performed. Both groups underwent ischemia-reperfusion injury, which included global ischemia for 20 minutes followed by reperfusion for 30 minutes. The group 2 (experimental) was preconditioned with creatine phosphate at a dose of 0.2 mmol/l for 5 min before ischemia. We registered cardiodynamic parameters and indicators of oxidative stress at the point of stabilization, at the 1st and 30th minutes of reperfusion. Results . With the impact of creatine phosphate at the 30th minute of reperfusion in the group 2 in comparison with group 1, there was found an increase in the maximum and minimum speed of pressure elevation in the left ventricle (1.7 and 1.9 times, respectively), and of systolic and diastolic pressure in the left ventricle (1.5 and 1.6 times, respectively). Biomarkers of oxidative stress (lipid peroxidation index, nitrites, superoxide anion radical and hydrogen peroxide) were also statistically significantly lower in the group 2 after the 1st minute of reperfusion (by 1.2 times, by 1.4 times, by 2.8 times and 1.9 times, respectively), and after the 30th minute (1.3 times, 2.1 times, 1.9 times and 2.1 times, respectively). Conclusion . The administration of creatine phosphate into the coronary flow 5 minutes before the onset of ischemia has a protective effect on myocardial contractility. Reduction of oxidative stress and damage can be considered as a protective effect of creatine phosphate.

Innovative use of Protek Duo during bilateral lung transplant with Veno-Arterial Extracorporeal Membrane Oxygenation assistance.

V-A ECMO during bilateral lung transplantation is routinely used when extracorporeal support is needed, in particular in case of patients affected by pulmonary hypertension. We report the case of a patient successfully transplanted with V-A ECMO assistance using a percutaneous double lumen cannula as venous drainage (Protek Duo, CardiacAssist Inc., Pittsburgh, PA) and central aortic cannulation. The double lumen cannula allowed an optimal drainage of the venous system and effective emptying of right heart chambers.

Cavoatrial hypernephroma resection on cardiopulmonary bypass: Mild/normo-versus moderate hypothermia.

Renal cell carcinoma (RCC) is one of the most prevalent malignant tumors. It extends up into the systemic veins and right atrium. Surgical extraction of such extensions is usually carried out using cardiopulmonary bypass (CPB) with moderate hypothermic (MH) being frequently applied in order to obtain a clear surgical field. However, due to obvious disadvantages of hypothermia, approaches with mild/normothermia (NT) during CPB have also been established. The current study aims to compare the outcomes of patients undergoing RCC tumor and extensions resection using MH versus NT. This is a retrospective, non-randomized study. All patients who underwent RCC tumor and extensions resection for stage III or IV (Staehler) RCC in a single center between 2006 and 2020 were included. During surgery, MH or NT were applied. CPB was realized using aortic and bicaval cannulation. We compared the procedural times, transfusion requirements and postoperative outcomes, respectively between the MH and NT groups. A total of 24 consecutive patients (n(NT) = 12, n(MH) = 12) were included in the study (median age NT 68.5 and MH 66.5). The study only showed a significant difference in heart-lung machine times (median CPB time NT 45.5 min and MH 110.0 min, p = 0.004). All other results, loss of drainage, administration of blood products, as well as the postoperative course and mortality were comparable in both groups. The results showed a high perioperative and long-term mortality. The perioperative course was similar after surgery with NT or MH. Therefore, NT which minimizes potential complications of MH should be preferred.

Echo-guided seldinger technique facilitates ascending aorta cannulation in type A aortic dissection

BackgroundThe ascending aorta is the most simple and rapid arterial access for the establishment of antegrade systemic perfusion. In acute type A aortic dissection, prompt establishment of antegrade central perfusion, especially in unstable hemodynamic emergency operations, help to diminish organ malperfusion and to prevent retrograde embolism. The effectiveness as well as the safety of antegrade perfusion under ultrasonographic guidance through the dissected ascending aorta was evaluated for the repair of type A aortic dissection utilizing a new echo stabilizer.ResultsAscending aortic cannulation was successfully performed in 64 consecutive patients, using the Seldinger technique, with the hands-free continuous-echo monitoring, utilizing a new stabilizer. Epiaortic 2-Dimensional and color Doppler imaging provided real-time monitoring for the placement and proper perfusion of ascending aorta cannulation.ConlusionsAscending aorta can routinely provide a rapid and reliable route of antegrade central systemic perfusion in type A acute aortic dissection. The echo-guided stabilizer-assisted cannulation method can safely provide a rapid and reliable route for antegrade central perfusion during in type A dissections repair.

Left axillary cannulation for acute type A aortic dissection

The most commonly used arterial cannulation sites for type A aortic dissection are right axillary artery, femoral artery and both. Direct central aortic cannulation has also been reported. In rare cases, it is extremely difficult to choose an arterial cannulation site for type A aortic dissection due to involvement of the right axillary and both femoral arteries. Herein, we present a 39-year-old male with acute type A aortic dissection with involvement of the right axillary and both femoral arteries. Left axillary cannulation was made and selective cerebral perfusion was performed through direct left common carotid artery cannulation during circulatory arrest. Surgery was performed to replace the ascending aorta and total arch combined with a frozen elephant trunk implantation. The patient recovered uneventfully. To our knowledge, this is a rare case of total aortic arch replacement with frozen elephant trunk implantation through left axillary arterial cannulation for type A aortic dissection in the literature. Left axillary cannulation is a safe and useful choice for type A aortic dissection surgery when right axillary and femoral cannulation are not safe and reliable.

Central versus peripheral cannulation for acute type A aortic dissection

ObjectiveThis study sought to evaluate the impact of central aortic versus peripheral cannulation on outcomes after acute type A aortic dissection repair. MethodsThis was an observational study using an institutional database of acute type A aortic dissection repairs from 2007 to 2021. Patients were stratified according to central, subclavian, or femoral cannulation. Kaplan–Meier survival estimation and multivariable Cox regression were performed. ResultsThe study population consisted of 577 patients who underwent acute type A aortic dissection repair. Of these, central cannulation was used in 490 patients (84.9%), subclavian cannulation was used in 54 patients (9.4%), and femoral cannulation was used in 33 patients (5.7%). Rates of peripheral vascular disease, aortic insufficiency moderate or greater, and cerebral malperfusion differed significantly among the groups, but baseline characteristics were otherwise comparable (P > .05). Operative mortality was lowest in the central cannulation group (9.8%), but this did not differ significantly among the groups. Kaplan–Meier survival estimates were similar among the groups. On multivariable Cox regression, cannulation strategy was not significantly associated with long-term survival. ConclusionsAcute type A aortic dissection repair can be safely performed through central aortic cannulation, with outcomes comparable to those obtained with subclavian or femoral cannulation.