1. Femoral arterial cannulation for surgical repair of stanford type A aortic dissection.
- Author
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Juvonen T, Vendramin I, Mariscalco G, Jormalainen M, Perrotti A, Hervé A, Mazzaro E, Gatti G, Pettinari M, Peterss S, Buech J, Nappi F, Pinto AG, Rodriguez Lega J, Pol M, Rocek J, Kacer P, Rukosujew A, Wisniewski K, Piani D, Demal T, Conradi L, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Fiore A, Folliguet T, Acharya M, El-Dean Z, Field M, Kuduvalli M, Onorati F, Francica A, Mäkikallio T, Dell'Aquila AM, Mustonen C, Raivio P, Rosato S, and Biancari F
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic mortality, Catheterization methods, Catheterization, Peripheral methods, Propensity Score, Retrospective Studies, Treatment Outcome, Aortic Dissection surgery, Aortic Dissection mortality, Femoral Artery surgery, Hospital Mortality
- Abstract
Background: The benefits and harms associated with femoral artery cannulation over other sites of arterial cannulation for surgical repair of acute Stanford type A aortic dissection (TAAD) are not conclusively established., Methods: We evaluated the outcomes after surgery for TAAD using femoral artery cannulation, supra-aortic arterial cannulation (i.e., innominate/subclavian/axillary artery cannulation), and direct aortic cannulation., Results: 3751 (96.1%) patients were eligible for this analysis. In-hospital mortality using supra-aortic arterial cannulation was comparable to femoral artery cannulation (17.8% vs. 18.4%; adjusted OR 0.846, 95% CI 0.799-1.202). This finding was confirmed in 1028 propensity score-matched pairs of patients with supra-aortic arterial cannulation or femoral artery cannulation (17.5% vs. 17.0%, p = 0.770). In-hospital mortality after direct aortic cannulation was lower compared to femoral artery cannulation (14.0% vs. 18.4%, adjusted OR 0.703, 95% CI 0.529-0.934). Among 583 propensity score-matched pairs of patients, direct aortic cannulation was associated with lower rates of in-hospital mortality (13.4% vs. 19.6%, p = 0.004) compared to femoral artery cannulation. Switching of the primary site of arterial cannulation was associated with increased rate of in-hospital mortality (36.5% vs. 17.0%; adjusted OR 2.730, 95% CI 1.564-4.765). Ten-year mortality was similar in the study cohorts., Conclusions: In this study, the outcomes of surgery for TAAD using femoral arterial cannulation were comparable to those using supra-aortic arterial cannulation. However, femoral arterial cannulation was associated with higher in-hospital mortality than direct aortic cannulation., Trial Registration: ClinicalTrials.gov registration code: NCT04831073., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
- Published
- 2024
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