Selecting The Arterial Cannulation Site In Acute Type A Aortic Dissection: Axillary Artery Or Femoral Artery?

The aim of this study was to investigate the effects of cannulation site (either the right axillary artery or the right/left main femoral artery) on the mortality and morbidity of postoperative acute type A aortic dissection (ATAAD) patients. A total of 41 ATAAD patients (male:female = 29:12), of whom 15 underwent cannulation of the right axillary and 26 of the common femoral artery, were retrospectively evaluated. Post-operative mortality and morbidity were assessed and statistically analyzed. Of the participants, 34 (82.9%) were type I and 7 (17.0%) were type II according to the DeBakey classification. Cerebral protection was achieved using deep hypothermia in 14 patients, and by antegrade cerebral perfusion in addition to deep hypothermia in 9 patients. Early postoperative mortality was 17% (n= 7). There were no significant differences between the axillary artery and femoral artery cannulation groups in terms of postoperative mortality and morbidity. However, a greater number of arcus aortic interventions was performed in the group undergoing axillary artery cannulation (Group II). In this group, the rate of antegrade cerebral perfusion was also higher. Although the cannulation site in patients with ATAAD was not determined to affect mortality and morbidity, both options present advantages and disadvantages. We believe that all relevant factors pertaining to the patient as well as the surgical procedure to be employed should be evaluated in tandem in selecting the optimal cannulation site.

PDF

___

Trimarchi S, Nienaber CA, Rampoldi V, et al. International Registry of Acute Aortic Dissection Investigators. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg 2005; 129: 112-122. Knipp BS, Deeb GM, Prager RL, Williams CY, Upchurch GR Jr, Patel HJ. A contemporary analysis of outcomes for operative repair of type A aortic dissection in the United States. Surgery 2007; 142: 524-528.

Neri E, Massetti M, Capannini G, et al. Axillary artery cannulation in type a aortic dissection operations. J Thorac Cardiovasc Surg 1999; 118: 324-329.

Kokotsakit J, Lazopoulos G, Milonakis M, et al. Right axillary artery cannulation for surgical management of the hostile ascending aorta. Tex Heart Inst J 2005; 32: 189-193.

Tiwari KK, Murzi M, Bevilacqua S, Glauber M. Which cannulation (ascending aortic cannulation or peripheral arterial cannulation) is better for acute type A aortic dissection surgery? Interact Cardiovasc Thorac Surg 2010; 10: 797-802.

Hoefer D, Ruttmann E, Riha M, et al. Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A. Ann Thorac Surg 2002; 73: 714-718.

Fujii H, Kitazawa Y, Saito F, Tsuda M, Yabuki T, Kajimoto S. Return to home early days after acute aortic dissection surgery. Minerva Chir 2006; 61: 509-514.

Conzelmann LO, Weigang E, Mehlhorn U, et al. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 2016; 49: 44-52.

Aalberts JJ, Boonstra PW, van den Berg MP, Waterbolk TW. In-hospital mortality and three-year survival after repaired acute type A aortic dissection. Neth Heart J 2009; 17: 226-231.

Etz CD, von Aspern K, da Rocha E Silva J, et al. Impact of perfusion strategy on outcome after repair for acute type a aortic dissection. Ann Thorac Surg 2014; 97: 78-85. Calvaruso D, Voisine P, Mohammadi S, Dumont E, Dagenais F. Axillary artery cannulation. Multimed Man Cardiothorac Surg 2012; 2012:mms004.

Lee HK, Kim GJ, Cho JY, Lee JT, Park I, Lee YO. Comparison of the Outcomes between Axillary and Femoral Artery Cannulation for Acute Type A Aortic Dissection. Korean J Thorac Cardiovasc Surg 2012; 45: 85-90.

Reuthebuch O, Schurr U, Hellermann J, et al. Advantages of subclavian artery perfusion for repair of acute type A dissection. Eur J Cardiothorac Surg 2004; 26: 592-598.

Stamou SC, Gartner D, Kouchoukos NT, et al. Axillary Versus Femoral Arterial Cannulation During Repair of Type A Aortic Dissection?: An Old Problem Seeking New Solutions. Aorta (Stamford) 2016; 4: 115-123.