Direct Aortic Versus Supra-Aortic Arterial Cannulation During Surgery for Acute Type A Aortic Dissection
Abstract
Aims: In this study we evaluated the impact of direct aortic cannulation versus innominate/subclavian/axillary artery cannulation on the outcome after surgery for type A aortic dissection.
Methods: The outcomes of patients included in a multicenter European registry (ERTAAD) who underwent surgery for acute type A aortic dissection with direct aortic cannulation versus those with innominate/subclavian/axillary artery cannulation, i.e. supra-aortic arterial cannulation, were compared using propensity score matched analysis.
Results: Out of 3902 consecutive patients included in the registry, 2478 (63.5%) patients were eligible for this analysis. Direct aortic cannulation was performed in 627 (25.3%) patients, while supra-aortic arterial cannulation in 1851 (74.7%) patients. Propensity score matching yielded 614 pairs of patients. Among them, patients who underwent surgery for TAAD with direct aortic cannulation had significantly decreased in-hospital mortality (12.7% vs. 18.1%, p = 0.009) compared to those who had supra-aortic arterial cannulation. Furthermore, direct aortic cannulation was associated with decreased postoperative rates of paraparesis/paraplegia (2.0 vs. 6.0%, p < 0.0001), mesenteric ischemia (1.8 vs. 5.1%, p = 0.002), sepsis (7.0 vs. 14.2%, p < 0.0001), heart failure (11.2 vs. 15.2%, p = 0.043), and major lower limb amputation (0 vs. 1.0%, p = 0.031). Direct aortic cannulation showed a trend toward decreased risk of postoperative dialysis (10.1 vs. 13.7%, p = 0.051).
Conclusions: This multicenter cohort study showed that direct aortic cannulation compared to supra-aortic arterial cannulation is associated with a significant reduction of the risk of in-hospital mortality after surgery for acute type A aortic dissection.
Trial registration: ClinicalTrials.gov Identifier: NCT04831073.
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Date
2023-11
Type
Article
Subject
Acute Type A Aortic Dissection, Direct Aortic Arterial Cannulation, Supra-Aortic Arterial Cannulation
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Citation
Juvonen, T., Jormalainen, M., Mustonen, C., Demal, T., Fiore, A., Perrotti, A., Hervé, A., Mazzaro, E., Gatti, G., Pettinari, M., Peterss, S., Buech, J., Nappi, F., Conradi, L., Pinto, A. G., Rodriguez Lega, J., Pol, M., Kacer, P., Dell'Aquila, A. M., Rukosujew, A., … Biancari, F. (2023). Direct Aortic Versus Supra-Aortic Arterial Cannulation During Surgery for Acute Type A Aortic Dissection. World journal of surgery, 47(11), 2899–2908. https://doi.org/10.1007/s00268-023-07116-z