Femoral cannulation continues to be safe for type A Aortic dissection repair
Anthony Lemaire, Dov Levine, Joshua Chao, Hirohisa Ikegami, Lauren Salgueiro, Mark J. Russo, Leonard Lee
Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
OBJECTIVE: The optimal cannulation site for repair of Type A Aortic dissection remains controversial. The concern for malperfusion syndrome and embolization has initiated a national trend away from femoral cannulation to axillary artery and direct ascending aortic cannulation. The purpose of this study was to report a single center experience with femoral artery cannulation for the repair of type A aortic dissection.
METHODS: A retrospective study was performed on 111 patients who underwent surgical repair for a Type A dissection between January 1st, 2011 and September 11th, 2019 at a single institution. A total of 116 arterial cannulations were performed. These consisted of 83 (71.6%) femoral, 16 (13.8%) ascending aorta, and 17 (14.7%) axillary cannulations. Deep hypothermic circulatory arrest was used in all the patients. Rates of postoperative complications and mortality were reported.
RESULTS: The mortality rate for all patients was 26.1% (29/111), with no difference observed between those undergoing femoral, axillary, ascending aorta cannulations (26.8%, 20.0%, 28.6%, respectively; p=0.88). None of the mortalities identified were directly attributable to the cannulation approach in each case. There was no statistically significant difference in rates of malperfusion directly due to cannulation strategy (1.2% femoral, 5.8% axillary, 6.3% ascending aorta; p=0.19). Similarly, there was no difference in bleeding rates at the site of cannulation (1.2% femoral, 0% axillary, 0% ascending aorta; p=1).
CONCLUSIONS: Despite the recent shift away from femoral cannulation, the results of the study show that femoral artery cannulation is safe and produces excellent results for establishing cardiopulmonary bypass.
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