Femoral Versus Axillary Cannulation in Acute Type - A Dissection Repair Surgery

Eilon Ram Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel Alexander Lipey Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel Leonid Sternik Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel Ami Shinfeld Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel Boris Orlov Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel Alexander Kogan Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel Ehud Raanani Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel

Objective: We compared early and late outcomes between patients who underwent femoral versus axillary cannulation for repair of acute type A aortic dissection.

Methods: Between 2004 and 2017, we retrospectively reviewed clinical outcomes of 135 consecutive patients who underwent emergency surgery for acute type A aortic dissection repair via femoral (n=84) or right axillary (n=51) artery cannulation. Mean patient age was 6312 years and 66% were male.

Results: Overall in-hospital mortality was 12.6% (axillary 15.7%, femoral 10.7%; p=0.430). Patients who underwent axillary compared to femoral artery cannulation had a non-statistically significant higher in-hospital mortality rate among stable and unstable patients (13% vs. 6.5%, p=0.319 and 40% vs. 22.7%, p=0.580; respectively) (Figure).While there was no difference in the major complication rates such as stroke, low cardiac output, and surgical revision, there was a higher incidence of renal failure that required dialysis in patients who underwent axillary cannulation (12% vs. 1%, p=0.012). Among those discharged from hospital, the 1, 2 and 3-year survival rate was 91%, 90% and 88% respectively.

Conclusions: Based on our experience, emergency surgery for both stable and unstable patients with acute type A aortic dissection demonstrated better survival and less renal impairment when using the femoral cannulation approach.

Presentation

Eilon Ram