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Does Arterial Cannulation Type in Aortic Dissection Repair Impact Outcomes?
Dov Levine, Joshua Chao, Marlena Sabatino, Hirohisa Ikegami, Mark J. Russo, Leonard Y. Lee, Anthony Lemaire.
Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Objective: Establishing cardiopulmonary bypass remains critical to the successful repair of an acute type A aortic dissection. A recent trend away from femoral arterial cannulation has occurred in part due to concerns of stroke risk from retrograde perfusion to the brain. The purpose of this study was to determine if arterial cannulation site impacts surgical outcomes.Methods: A retrospective chart review was performed at an academic institution from January 1st, 2011 to March 8th, 2021. Of the 135 patients included, 98 (73%) underwent femoral arterial cannulation, 21 (16%) axillary cannulation, and 16 (12%) direct aorta cannulation. The study variables included demographic data, cannulation site, and complications.Results: The mean age was 63.6 +/- 14 years, with no difference between the femoral, axillary, and direct cannulation groups (Table 1). 84 patients (62%) were male, with similar percentages amongst each group. Rates of bleeding, stroke, and mortality specifically due to the arterial cannulation did not significantly differ based on cannulation site (Table 2). Just one patient had a stroke attributable to the femoral cannulation. No patients died as a direct complication of arterial access. Overall in-hospital mortality was 22%, similar between groups.Conclusions: This study found no statistically significant different in rates of stroke or other complications based on cannulation site. Femoral arterial cannulation thus remains a safe and efficient choice for arterial cannulation in the repair of acute type A aortic dissection.
Table 1. Demographic Data

OverallFemoral CannulationAxillary CannulationDirection Cannulationp-value
Number (%)13598 (73)21 (16)16 (12)
Age (years)63.6 +/- 1462.6 +/- 1465.9 +/- 1763.4 +/- 140.763
Gender (male) (n) (%)84 (62)60 (61)14 (67)10 (63)0.958
African American28 (21)25 (26)3 (14)0 (0)0.017
Asian13 (10)8 (8)3 (14)2 (13)
Hispanic5 (4)2 (2)2 (10)1 (6)
Caucasian77 (58)55 (57)9 (43)13 (81)
Other10 (8)6 (6)4 (19)0 (0)
Body Surface Area (m2)2.00 +/- 0.312.03 +/- 0.331.90 +/- 0.251.97 +/- 0.220.2

Table 2. Complications
OverallFemoral CannulationAxillary CannulationDirection Cannulationp-value
Bleeding From Cannulation (n) (%)1 (1)1 (1)NoneNone1
Stroke From Cannulation1 (1)1 (1)NoneNone1
Mortality From CannulationNoneNoneNoneNone
In-Hospital Mortality30 (22)22 (22)3 (14)5 (31)0.468

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