Is Axillary Better Than Femoral Artery Cannulation in Repair of Acute Type A Aortic Dissection?

Abstract

Objective

We compared early and late outcomes of patients who underwent femoral versus axillary artery cannulation for repair of acute type A aortic dissection.

Methods

Between 2004 and 2017, we retrospectively evaluated the clinical outcomes of 135 consecutive patients who underwent emergency surgery for acute type A aortic dissection repair. Patients were divided into 2 groups: those who underwent femoral (n = 84) and those who underwent right axillary (n = 51) artery cannulation. Mean patient age was 63 ± 13 years and 88 (65%) were male.

Results

Overall operative mortality was 12.6% (axillary 15.7%, femoral 10.7%; P = 0.564). Patients who underwent axillary compared to femoral artery cannulation had a statistically nonsignificant higher operative mortality rate among both stable and unstable patients (13% vs. 6.5%, P = 0.405 and 40% vs. 22.7%, P = 0.818, respectively). While there was no difference in major complication rates, such as stroke, low cardiac output, and surgical revision for bleeding/tamponade, there was a higher incidence of renal failure that required dialysis in patients who underwent axillary cannulation (12% vs. 1%, P = 0.022). Multivariate analysis demonstrated that predictors for the composite endpoint of operative mortality or severe organ malperfusion, such as renal failure or cerebrovascular accident, were hemodynamic instability on admission (OR 3.87; 95% CI, 1.23 to 12.63; P = 0.021), lower preoperative creatinine clearance (OR 0.94; 95% CI, 0.90 to 0.97; P < 0.001); and the use of axillary artery cannulation (OR 4.1; 95% CI, 1.43 to 12.78; P = 0.011). Among those discharged from hospital, the 3-year survival rate was 91% in the axillary group and 87% in the femoral group (P = 0.772).

Conclusions

Based on our experience, emergent surgery for both stable and unstable patients with acute type A aortic dissection demonstrated similar survival rates and significantly less renal impairment when using the femoral cannulation approach.

Keywords

ascending aorta dissection type A dissection deBakey I dissection deBakey II dissection arterial cannulation

Get full access to this article

View all access options for this article.

References

El-Hamamsy

Ouzounian

Demers

McClure

Hassan

Dagenais

Chu

MWA

Pozeg

Bozinovski

Peterson

et al. State-of-the-art surgical management of acute type A aortic dissection. Can J Cardiol. 2016;32(1):100–109.doi:10.1016/j.cjca.2015.07.736

Hagan

Nienaber

Isselbacher

Bruckman

Karavite

Russman

Evangelista

Fattori

Suzuki

et al. The International Registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA. 2000;283(7):897–903.

Lee

Kon

Cheema

Grau-Sepulveda

Englum

Kim

Chaudhuri

Thourani

Ailawadi

Hughes

et al. Contemporary management and outcomes of acute type A aortic dissection: an analysis of the Sts adult cardiac surgery database. J Card Surg. 2018;33(1):7–18. doi:10.1111/jocs.13511

Pape

Awais

Woznicki

Suzuki

Trimarchi

Evangelista

Myrmel

Larsen

Harris

Greason

et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015;66(4):350–358.doi:10.1016/j.jacc.2015.05.029

Tokuda

Miyata

Motomura

Oshima

Usui

Takamoto

Japan Adult Cardiovascular Database Organization . Brain protection during ascending aortic repair for Stanford type A acute aortic dissection surgery. nationwide analysis in Japan. Circ J. 2014;78(10):2431–2438.doi:10.1253/circj.CJ-14-0565

Fusco

Shaw

Tranquilli

Kopf

Elefteriades

. Femoral cannulation is safe for type a dissection repair. Ann Thorac Surg. 2004;78(4):1285–1289. Discussion 1285-9.doi:10.1016/j.athoracsur.2004.04.072

Gulbins

Pritisanac

Ennker

. Axillary versus femoral cannulation for aortic surgery: enough evidence for a general recommendation? Ann Thorac Surg. 2007;83(3):1219–1224.doi:10.1016/j.athoracsur.2006.10.068

Benedetto

Mohamed

Vitulli

Petrou

. Axillary versus femoral arterial cannulation in type A acute aortic dissection: evidence from a meta-analysis of comparative studies and adjusted risk estimates. Eur J Cardiothorac Surg. 2015;48(6):953–959.doi:10.1093/ejcts/ezv035

Ren

Wang

Deng

Zhou

Jiang

. Which cannulation (axillary cannulation or femoral cannulation) is better for acute type A aortic dissection repair? A meta-analysis of nine clinical studies. Eur J Cardiothorac Surg. 2015;47(3):408–415.doi:10.1093/ejcts/ezu268

10.

Conzelmann

Weigang

Mehlhorn

Abugameh

Hoffmann

Blettner

Etz

Czerny

Vahl

GERAADA Investigators

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(2):e44–e52.doi:10.1093/ejcts/ezv356

11.

Patris

Toufektzian

Field

Argiriou

. Is axillary superior to femoral artery cannulation for acute type A aortic dissection surgery? Interact Cardiovasc Thorac Surg. 2015;21(4):515–520.doi:10.1093/icvts/ivv181

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.03 MB

0.00 MB