BACKGROUND: The benefits and harms associated with femoral artery cannulation over other sites of arterial cannulation for surgical repair of acute Stanford type A aortic dissection (TAAD) are not conclusively established. METHODS: We evaluated the outcomes after surgery for TAAD using femoral artery cannulation, supra-aortic arterial cannulation (i.e., innominate/subclavian/axillary artery cannulation), and direct aortic cannulation. RESULTS: 3751 (96.1%) patients were eligible for this analysis. In-hospital mortality using supra-aortic arterial cannulation was comparable to femoral artery cannulation (17.8% vs. 18.4%; adjusted OR 0.846, 95% CI 0.799-1.202). This finding was confirmed in 1028 propensity score-matched pairs of patients with supra-aortic arterial cannulation or femoral artery cannulation (17.5% vs. 17.0%, p = 0.770). In-hospital mortality after direct aortic cannulation was lower compared to femoral artery cannulation (14.0% vs. 18.4%, adjusted OR 0.703, 95% CI 0.529-0.934). Among 583 propensity score-matched pairs of patients, direct aortic cannulation was associated with lower rates of in-hospital mortality (13.4% vs. 19.6%, p = 0.004) compared to femoral artery cannulation. Switching of the primary site of arterial cannulation was associated with increased rate of in-hospital mortality (36.5% vs. 17.0%; adjusted OR 2.730, 95% CI 1.564-4.765). Ten-year mortality was similar in the study cohorts. CONCLUSIONS: In this study, the outcomes of surgery for TAAD using femoral arterial cannulation were comparable to those using supra-aortic arterial cannulation. However, femoral arterial cannulation was associated with higher in-hospital mortality than direct aortic cannulation. TRIAL REGISTRATION: ClinicalTrials.gov registration code: NCT04831073.

Cardiac Surgery Molinette Hospital University of Turin Turin Italy

Cardiothoracic Department Udine University Hospital Udine Italy

Cardiovascular Surgery Department University Hospital Gregorio Marañón Madrid Spain

Chirurgie Cardio thoraco Vasculaire Cliniques Universitaire Saint Luc Brussel Belgium

Department of Cardiac Surgery 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Cardiac Surgery Centre Cardiologique du Nord de Saint Denis Paris France

Department of Cardiac Surgery Centre Hospitalier Annecy Genevois Epagny Metz Tessy France

Department of Cardiac Surgery Glenfield Hospital Leicester UK

Department of Cardiac Surgery Hôpitaux Universitaires Henri Mondor Assistance Publique Hôpitaux de Paris Creteil France

Department of Cardiac Surgery Martin Luther University Halle Wittenberg Halle Germany

Department of Cardiothoracic Surgery University Hospital Muenster Muenster Germany

Department of Cardiovascular Surgery Hospital Clínic de Barcelona University of Barcelona Barcelona Spain

Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany

Department of Medicine South Karelia Central Hospital University of Helsinki Lappeenranta Finland

Department of Thoracic and Cardiovascular Surgery University of Franche Comte Besancon France

Division of Cardiac Surgery Cardio thoracic and Vascular Department Azienda Sanitaria Universitaria Giuliano Isontina Trieste Italy

Division of Cardiac Surgery University of Verona Medical School Verona Italy

Faculty of Medicine University of Oulu Oulu Finland

German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany

Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland

Liverpool Centre for Cardiovascular Sciences Liverpool Heart and Chest Hospital Liverpool UK

LMU University Hospital Ludwig Maximilian University Munich Germany

National Centre for Global Health National Health Institute Rome Italy

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Zhang, Yi, Yuanyuan Yang, Jinhua Guo, Xiaotian Zhang, Yunqing Cheng, Tucheng Sun, and Lixia Lin. 2023. “Risk Factors for Early Death after Surgery in Patients with Acute Stanford Type A Aortic Dissection: A Systematic Review and Meta‐Analysis.” International Journal of Cardiology 15(377): 33–41. https://doi.org/10.1016/j.ijcard.2022.12.013.

Pompilio, Giulio, Rita Spirito, Francesco Alamanni, Marco Agrifoglio, Gianluca Polvani, Massimo Porqueddu, Matteo Reali, and Paolo Biglioli. 2001. “Determinants of Early and Late Outcome after Surgery for Type A Aortic Dissection.” World Journal of Surgery 25(12): 1500–1506. https://doi.org/10.1007/s00268‐001‐0160‐y.

Lin, C.‐Yu, C.‐Yu Lee, H.‐Fu Lee, M.‐Yu Wu, C.‐Nan Tseng, F.‐Chun Tsai, and Y.‐Hsuan Lin. 2022. “Postoperative Stroke after Type A Aortic Dissection Repair: Hemorrhage Versus Ischemia.” World Journal of Surgery 46(3): 690–700. https://doi.org/10.1007/s00268‐021‐06375‐y.

Hussain, Azhar, Mohsin Uzzaman, Sameh Mohamed, Fakyha Khan, Salman Butt, and Habib Khan. 2021. “Femoral Versus Axillary Cannulation in Acute Type A Aortic Dissections: A Meta‐Analysis.” Journal of Cardiac Surgery 36(10): 3761–3769. https://doi.org/10.1111/jocs.15810.

Benedetto, U., H. Mohamed, P. Vitulli, and M. Petrou. 2015. “Axillary Versus Femoral Arterial Cannulation in Type A Acute Aortic Dissection: Evidence from a Meta‐Analysis of Comparative Studies and Adjusted Risk Estimates.” European Journal of Cardio‐Thoracic Surgery 48(6): 953–959. https://doi.org/10.1093/ejcts/ezv035.

Juvonen, Tatu, Mikko Jormalainen, Caius Mustonen, Till Demal, Antonio Fiore, Andrea Perrotti, Amélie Hervé, et al. 2023. “Direct Aortic Versus Supra‐aortic Arterial Cannulation During Surgery for Acute Type A Aortic Dissection.” World Journal of Surgery 47(11): 2899–2908. https://doi.org/10.1007/s00268‐023‐07116‐z.

Malaisrie, S. Christopher, Wilson Y. Szeto, Monika Halas, Leonard N. Girardi, Joseph S. Coselli, Thoralf M. Sundt, Edward P. Chen, et al. 2021. “2021 the American Association for Thoracic Surgery Expert Consensus Document: Surgical Treatment of Acute Type A Aortic Dissection.” The Journal of Thoracic and Cardiovascular Surgery 162(3): 735–758. https://doi.org/10.1016/j.jtcvs.2021.04.053.

Isselbacher, Eric M., Ourania Preventza, James Hamilton Black, John G. Augoustides, Adam W. Beck, Michael A. Bolen, Alan C. Braverman, et al. (2022) “ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.” Circulation 46(24): e334–e482. https://doi.org/10.1161/cir.0000000000001106.

Ren, Zongli, Zhiwei Wang, Rui Hu, Hongbing Wu, Hongping Deng, Zhen Zhou, Xiaoping Hu, and Wanli Jiang. 2015. “Which Cannulation (Axillary Cannulation or Femoral Cannulation) Is Better for Acute Type A Aortic Dissection Repair? A Meta‐Analysis of Nine Clinical Studies.” European Journal of Cardio‐Thoracic Surgery 47(3): 408–415. https://doi.org/10.1093/ejcts/ezu268.

Helder, Meghana R. K., Hartzell V. Schaff, Courtney N. Day, Alberto Pochettino, Gabor Bagameri, Kevin L. Greason, Steven L. Lansman, Leonard N. Girardi, Curtis B. Storlie, and Elizabeth B. Habermann. 2020. “Regional and Temporal Trends in the Outcomes of Repairs for Acute Type A Aortic Dissections.” Ann Thorac Surg 109(1): 26–33. https://doi.org/10.1016/j.athoracsur.2019.06.058.

Borst, H. G., J. Laas, and M. Heinemann. 1991. “Type A Aortic Dissection: Diagnosis and Management of Malperfusion Phenomena.” Seminars in Thoracic and Cardiovascular Surgery 3: 238–241.

Khoynezhad, A., and K. A. Plestis. 2006. “Cannulation in the Diseased Aorta: A Safe Approach Using the Seldinger Technique.” Texas Heart Institute Journal 33: 353–355.

Shimura, Shinichiro, Shigeto Odagiri, Hidekazu Furuya, Kimiaki Okada, Keisuke Ozawa, Haruhiro Nagase, Masaomi Yamaguchi, and Yasunori Cho. 2020. “Echocardiography‐guided Aortic Cannulation by the Seldinger Technique for Type A Dissection with Cerebral Malperfusion.” The Journal of Thoracic and Cardiovascular Surgery 159(3): 784–793. https://doi.org/10.1016/j.jtcvs.2019.02.097.

Kamiya, Hiroyuki, Klaus Kallenbach, Dominique Halmer, Merve Özsöz, Kathrin Ilg, Artur Lichtenberg, and Matthias Karck. 2009. “Comparison of Ascending Aorta Versus Femoral Artery Cannulation for Acute Aortic Dissection Type A.” Circulation 120(11 Suppl): S282–S286. https://doi.org/10.1161/circulationaha.108.844480.

Ma, Hao, Zhenghua Xiao, Jun Shi, Lulu Liu, Chaoyi Qin, and Yingqiang Guo. 2018. “Aortic Arch Cannulation with the Guidance of Transesophageal Echocardiography for Stanford Type A Aortic Dissection.” Journal of Cardiothoracic Surgery 13(1): 106. https://doi.org/10.1186/s13019‐018‐0779‐5.

Kreibich, Maximilian, Zehang Chen, Bartosz Rylski, Joseph E. Bavaria, Chase R. Brown, Emanuela Branchetti, Prashanth Vallabhajosyula, Wilson Y. Szeto, and Nimesh D. Desai. 2019. “Outcome after Aortic, Axillary, or Femoral Cannulation for Acute Type A Aortic Dissection.” The Journal of Thoracic and Cardiovascular Surgery 158(1): 27–34. https://doi.org/10.1016/j.jtcvs.2018.11.100.

Reece, T. Brett, Curtis G. Tribble, Robert L. Smith, R. Ramesh Singh, Brendon M. Stiles, Benjamin B. Peeler, John A. Kern, and Irving L. Kron. 2007. “Central Cannulation Is Safe in Acute Aortic Dissection Repair.” The Journal of Thoracic and Cardiovascular Surgery 133(2): 428–434. https://doi.org/10.1016/j.jtcvs.2006.09.059.

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ClinicalTrials.gov
NCT04831073