Axillary vs Femoral Arterial Cannulation in Acute Type A Dissection: International Multicenter Data

Malak Elbatarny; Santi Trimarchi; Amit Korach; Marco Di Eusanio; Davide Pacini; Raffi Bekeredjian; Truls Myrmel; Joseph E Bavaria; Nimesh D Desai; Ibrahim Sultan; Derek R Brinster; Chih-Wen Pai; Kim A Eagle; Himanshu J Patel; Mark D Peterson; IRAD Investigators

doi:10.1016/j.athoracsur.2024.02.026

Axillary vs Femoral Arterial Cannulation in Acute Type A Dissection: International Multicenter Data

Ann Thorac Surg. 2024 Mar 7:S0003-4975(24)00170-X. doi: 10.1016/j.athoracsur.2024.02.026. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
² Division of Cardiac Surgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
³ Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
⁴ Cardiac Surgery Unit, University of Medicine of Ancona, Ancona, Italy.
⁵ Division of Cardiac Surgery, University Hospital S. Orsola, Bologna, Italy.
⁶ Department of Cardiology and Angiology, Robert-Bosch Hospital, Stuttgart, Germany.
⁷ Department of Clinical Medicine, Tromso University Hospital, Tromso, Norway.
⁸ Division of Cardiothoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
⁹ Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
¹⁰ Department of Cardiothoracic Surgery, Northwell Health, New York City, New York.
¹¹ Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan.
¹² Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan.
¹³ Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York. Electronic address: mark.peterson@nyulangone.org.

PMID: 38458510
DOI: 10.1016/j.athoracsur.2024.02.026

Abstract

Background: Cannulation strategy in acute type A dissection (ATAD) varies widely without known gold standards. This study compared ATAD outcomes of axillary vs femoral artery cannulation in a large cohort from the International Registry of Acute Aortic Dissection (IRAD).

Methods: The study retrospectively reviewed 2145 patients from the IRAD Interventional Cohort (1996-2021) who underwent ATAD repair with axillary or femoral cannulation (axillary group: n = 1106 [52%]; femoral group: n = 1039 [48%]). End points included the following: early mortality; neurologic, respiratory, and renal complications; malperfusion; and tamponade. All outcomes are presented as axillary with respect to femoral.

Results: The proportion of patients younger than 70 years in both groups was similar (n = 1577 [74%]), as were bicuspid aortic valve, Marfan syndrome, and previous dissection. Patients with femoral cannulation had slightly more aortic insufficiency (408 [55%] vs 429 [60%]; P = .058) and coronary involvement (48 [8%] vs 70 [13%]; P = .022]. Patients with axillary cannulation underwent more total aortic arch (156 [15%] vs 106 [11%]; P = .02) and valve-sparing root replacements (220 [22%] vs 112 [12%]; P < .001). More patients with femoral cannulation underwent commissural resuspension (269 [30.9%] vs 324 [35.3%]; P = .05). Valve replacement rates were not different. The mean duration of cardiopulmonary bypass was longer in the femoral group (190 [149-237] minutes vs 196 [159-247] minutes; P = .037). In-hospital mortality was similar between the axillary (n = 165 [15%]) and femoral (n = 149 [14%]) groups (P = .7). Furthermore, there were no differences in stroke, visceral ischemia, tamponade, respiratory insufficiency, coma, or spinal cord ischemia.

Conclusions: Axillary cannulation is associated with a more stable ATAD presentation, but it is a more extensive intervention compared with femoral cannulation. Both procedures have equivalent early mortality, stroke, tamponade, and malperfusion outcomes after statistical adjustment.