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

2019 ◽  
Vol 14 (2) ◽  
pp. 124-133 ◽  
Author(s):  
Eilon Ram ◽  
Yoav Krupik ◽  
Alexander Lipey ◽  
Ami Shinfeld ◽  
Yael Peled ◽  
...  
Keyword(s):  
Renal Failure ◽  
Aortic Dissection ◽  
Femoral Artery ◽  
Operative Mortality ◽  
Axillary Artery ◽  
Type A ◽  
Acute Type ◽  
Complication Rates ◽  
Type A Aortic Dissection ◽  
Artery Cannulation

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.

scholarly journals Femoral artery cannulation combined with axillary artery cannulation is safe for Stanford type A aortic dissection

2020 ◽  
Author(s):  
Ling-chen Huang ◽  
Qi-chen Xu ◽  
Dao-zhong Chen ◽  
Xiao-fu Dai ◽  
Liang-wan Chen
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Femoral Artery ◽  
Axillary Artery ◽  
Type A ◽  
Clinical Results ◽  
Type A Aortic Dissection ◽  
Artery Cannulation ◽  
Surgical Data ◽  
Perfusion Time

Abstract Background The optimal cannulation strategy in surgery for Stanford type A aortic dissection is critical to the patients’ survival, but remains controversial. Different cannulation strategies have their own advantages and drawbacks during cardiopulmonary bypass. Our center used femoral and axillary artery cannulation for Stanford type A aortic dissection. The purpose of this study was to review and clarify the clinic outcome of femoral artery cannulation combined with axillary artery cannulation for the treatment of type A aortic dissection. Methods We performed a retrospective study that included 327 patients who were surgically treated for type A aortic dissection in our institution from January 2017 to June 2019.Using femoral and axillary artery cannulation to establish cardiopulmonary bypass in patients with type A aortic dissection. The demographics data and surgical data, clinical results of the patients were calculated. Results Femoral artery combined with axillary artery cannulation was technically successful in 327 patients. The cardiopulmonary bypass time was 141.60 ± 34.89 minutes, and the selective antegrade cerebral perfusion time was 14.94 ± 2.76 minutes. The early mortality was 3.06%. The incidence of permanent neurologic dysfunction was 0.92%. Sixteen patients had post-operative renal insufficiency and five patients with liver failure. Two patients ended up with paraplegia. Conclusion Femoral artery combined with axillary artery cannulation for type A aortic dissection can significantly reduce the occurrence of malperfusion syndrome and nervous system complications, especially for cerebral protection.

scholarly journals Comparison of Femoral and Axillary Artery Cannulation in Acute Type A Aortic Dissection Surgery

2020 ◽  
Vol 35 (1) ◽  
Author(s):  
Orhan Gokalp ◽  
Levent Yilik ◽  
Hasan Iner ◽  
Nihan Karakas Yesilkaya ◽  
Yuksel Besir ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Axillary Artery ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Artery Cannulation

scholarly journals Combined femoral and axillary perfusion strategy for Stanford type A aortic dissection repair

2020 ◽  
Author(s):  
Ling-chen Huang ◽  
Qi-chen Xu ◽  
Dao-zhong Chen ◽  
Xiao-fu Dai ◽  
Liang-wan Chen
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Femoral Artery ◽  
Axillary Artery ◽  
Demographic Data ◽  
Type A ◽  
Clinical Results ◽  
Type A Aortic Dissection ◽  
Artery Cannulation ◽  
Surgical Data

Abstract Background: The optimal cannulation strategy in surgery for Stanford type A aortic dissection is critical to patient survival but remains controversial. Different cannulation strategies have their own advantages and drawbacks during cardiopulmonary bypass. Our centre used a combined femoral and axillary perfusion strategy for the surgical treatment of type A aortic dissection. The purpose of this study was to review and clarify the clinical outcome of femoral artery cannulation combined with axillary artery cannulation for the treatment of Stanford type A aortic dissection.Methods: We performed a retrospective study that included 327 patients who were surgically treated for type A aortic dissection in our institution from January 2017 to June 2019. Femoral and axillary artery cannulation was used to establish cardiopulmonary bypass in patients with type A aortic dissection. The demographic data, surgical data, and clinical results of the patients were calculated.Results: Femoral artery combined with axillary artery cannulation was technically successful in 327 patients. The cardiopulmonary bypass time was 141.60 ± 34.89 minutes, and the selective antegrade cerebral perfusion time was 14.94 ± 2.76 minutes. The early mortality rate was 3.06%. The incidence of permanent neurologic dysfunction was 0.92%. Sixteen patients had postoperative renal insufficiency, and five patients had liver failure.Conclusion: Femoral artery combined with axillary artery cannulation for type A aortic dissection can significantly improve the prognosis of patients, especially in terms of cerebral protection, and can reduce the occurrence of adverse malperfusion syndrome and neurological complications.

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

Aorta ◽  
2016 ◽  
Vol 04 (04) ◽  
pp. 115-123 ◽  
Author(s):  
Sotiris Stamou ◽  
Derek Gartner ◽  
Nicholas Kouchoukos ◽  
Kevin Lobdell ◽  
Kamal Khabbaz ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Cox Regression ◽  
Type A ◽  
Acute Type ◽  
Arterial Cannulation ◽  
Actuarial Survival ◽  
Type A Aortic Dissection ◽  
Artery Cannulation ◽  
Cannulation Site

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.

Axillary Artery Cannulation Improves Operative Results for Acute Type A Aortic Dissection

2005 ◽  
Vol 80 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Yoshimasa Moizumi ◽  
Naotaka Motoyoshi ◽  
Kei Sakuma ◽  
Seijiro Yoshida
Keyword(s):  
Aortic Dissection ◽  
Axillary Artery ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Operative Results ◽  
Artery Cannulation
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