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CC BY-NC-ND 4.0 · Aorta (Stamford) 2024; 12(04): 080-085
DOI: 10.1055/s-0045-1802993
Original Research Article

A Retrospective Cohort Study Comparing Different Cannulation Strategies in Type A Aortic Dissection Surgery: 20-year Single-Center Experience in a Referral Center

Nicolas Nunez-Ordonez 
1   Cardiovascular Surgery Department, Fundacion Cardioinfantil-LaCardio, Bogotá, Colombia
2   Cardiovascular Surgery Resident, Faculty of Medicine, Universidad del Rosario, Bogotá, Colombia
,
Julian Senociain 
1   Cardiovascular Surgery Department, Fundacion Cardioinfantil-LaCardio, Bogotá, Colombia
,
Juan Pablo Umaña 
1   Cardiovascular Surgery Department, Fundacion Cardioinfantil-LaCardio, Bogotá, Colombia
3   Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Florida, Florida
,
Andres Felipe Amado-Olivares 
1   Cardiovascular Surgery Department, Fundacion Cardioinfantil-LaCardio, Bogotá, Colombia
,
Carlos Andrés Villa 
1   Cardiovascular Surgery Department, Fundacion Cardioinfantil-LaCardio, Bogotá, Colombia
,
Carlos Obando 
1   Cardiovascular Surgery Department, Fundacion Cardioinfantil-LaCardio, Bogotá, Colombia
,
Jaime Camacho 
1   Cardiovascular Surgery Department, Fundacion Cardioinfantil-LaCardio, Bogotá, Colombia
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Abstract

Background

Type A aortic dissection as a highly lethal disease continues being a great challenge for cardiac surgeons worldwide. There are still unanswered questions regarding intraoperative decisions and their impact on the surgical outcomes. The aim of this study is to compare postoperative outcomes according to site of cannulation in patients with acute Type A aortic dissection (ATAAD).

Methods

This was a retrospective cohort study. We included all ATAAD procedures from January 2002 to November 2023. We defined groups according to site of cannulation (aorta, axillary, femoral, innominate). Data from pre-, intra-, and postoperative variables were collected. Our main outcomes were spinal cord injury (SCI), stroke rate, and in-hospital mortality. Between-group comparisons were performed using standard statistical tests and post hoc tests adjusting for multiple comparisons were performed.

Results

We identified 127 ATAAD procedures. Reoperation for bleeding was significantly higher in the femoral cannulation group (75%, p = 0.0006). There were no statistically significant differences in acute kidney injury rate (p = 0.012), SCI rate (p = 0.78), or in-hospital mortality (p = 0.75). Our data suggest that there is a lower stroke rate in the axillary cannulation group (3.6%, p = 0.4), which did not reach statistical significance.

Conclusion

Choosing an adequate cannulation site is a critical step in TAAD surgery. In our series, axillary and innominate cannulation were the preferred methods with relatively low complication rates.

Keywords

Type A aortic dissection - cannulation strategy - stroke - spinal cord injury


Publikationsverlauf

Eingereicht: 11. Dezember 2023

Angenommen: 10. Oktober 2024

Artikel online veröffentlicht:
17. Februar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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