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CC BY 4.0 · Aorta (Stamford) 2016; 04(04): 115-123
DOI: 10.12945/j.aorta.2016.16.007
Original Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Axillary Versus Femoral Arterial Cannulation During Repair of Type A Aortic Dissection?

An Old Problem Seeking New Solutions
Sotiris C. Stamou
1   Department of Cardiovascular Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
,
Derek Gartner
1   Department of Cardiovascular Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
,
Nicholas T. Kouchoukos
2   Division of Cardiothoracic Surgery, Missouri Baptist Medical Center, Saint Louis, Missouri, USA
,
Kevin W. Lobdell
3   Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina, USA
,
Kamal Khabbaz
4   Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
,
Edward Murphy
5   Thoracic and Cardiovascular Surgery, Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute, Grand Rapids, Michigan, USA
,
Robert C. Hagberg
6   Department of Cardiac Surgery, Hartford Hospital, Hartford, Connecticut, USA
› Author Affiliations
Further Information

Publication History

29 February 2016

15 July 2016

Publication Date:
24 September 2018 (online)

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Abstract

Background: The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation.

Methods: A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality, and Cox regression hazard ratios were calculated to determine predictors of long-term mortality.

Results: Operative mortality was not influenced by cannulation site (16% for axillary cannulation vs. 19% for femoral cannulation, p = 0.64). In multivariate logistic regression analysis, hemodynamic instability (p < 0.001) and prolonged cardiopulmonary bypass time (>200 min; p = 0.05) emerged as independent predictors of operative mortality. Stroke rates were comparable between the two techniques (14% for axillary and 17% for femoral cannulation, p = 0.52). Five-year actuarial survival was comparable between the groups (55.1% for axillary and 65.7% for femoral cannulation, p = 0.36). In Cox regression analysis, predictors of long-term mortality were: age (p < 0.001), stroke (p < 0.001), prolonged cardiopulmonary bypass time (p = 0.001), hemodynamic instability (p = 0.002), and renal failure (p = 0.001).

Conclusions: The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles.

Key Words

Aortic dissection - Outcomes - Axillary cannulation - Femoral cammulation - Aorta - Dissection
 

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