Eastern Cardiothoracic Surgical Society

Right Axillary Cannulation in Patients with Type A Aortic Dissection with Dissected Innominate or Right Axillary Arteries
Maximilian Kreibich, Emanuela Branchett, Joseph Bavaria, Prashanth Vallabhajosyula, Wilson Szeto, Nimesh D. Desai, Hospital of the University of Pennsylvania, Philadelphia, PA

OBJECTIVE: The ideal arterial cannulation site for patients with Type A aortic dissection remains controversial, especially when the innominate or the right axillary arteries are involved. Aim of this study was to evaluate the outcome for axillary and non-axillary cannulation in this patient collective.

METHODS: From 2002 to 2017, 210 patients were surgically treated for Type A aortic dissection involving the innominate artery. Of those, axillary cannulation was performed in 38 patients compared to 172 patients with non-axillary cannulation. Perioperative details, complications, and survival were analyzed.

RESULTS: The distal aortic repair differed significantly between the two groups: hemi-arch replacement was performed more often in the non-axillary group (axillary: n=27 (71%), non-axillary: n=158 (92%); p<0.00), while total-arch replacement was performed more often in the axillary group (axillary: n=10 (26%), non-axillary: n=12 (7%); p<0.00). Similar rates of postoperative stroke were observed: axillary: n=5 (13%), non-axillary: n=30 (17%); p=0.498. The aortic dissection extended into the axillary artery in nine patients in the axillary group, and new postoperative stroke was observed in one of those patients. In-hospital mortality was comparable between the groups: axillary: n=5 (13%), non-axillary: n=18 (10%); p=0.630.

CONCLUSIONS: Cannulation of right axillary arteries in patients with Type A aortic dissection with involvement of the innominate artery does not result in worse clinical outcome and can safely be performed.