Direct aortic versus peripheral arterial cannulation in surgery for type-A aortic dissection

Introduction: It is controversial whether peripheral arterial cannulation may achieve better results than direct aortic cannulation during surgery for Stanford type A aortic dissection (TAAD).

Material and method: 309 consecutive patients underwent surgical repair for acute TAAD from January 2005 to December 2017 at the Helsinki University Hospital, Finland. The outcomes after surgery with direct aortic cannulation were compared with surgery using peripheral arterial cannulation.

Results and Discussion: Direct aortic cannulation was employed in 80 patients and peripheral arterial cannulation in 229 patients. Patients who underwent surgery with direct aortic cannulation had hospital mortality (13.8% vs. 13.5%, p=0.962) and stroke/global brain ischemia (22.3% vs. 25.0%, p=0.617) similar to those with peripheral arterial cannulation. Other secondary outcomes were equally distributed between the unmatched study cohorts. Among 74 propensity score matched pairs, direct aortic cannulation had hospital mortality (12.2% vs. 9.5%, p=0.804) and stroke/global brain ischemia rates (21.6% vs. 21.6%, p=1.000) comparable to peripheral arterial cannulation. The composite outcome of hospital mortality/stroke/global brain ischemia (29.7% vs. 27.0%, p=0.855), multiple stroke (16.2% vs. 17.6%, p=1.000), renal replacement therapy (11.8% vs. 13.0%, p=1.000) and length of stay in the intensive care unit (mean, 4.9±4.5 vs. 4.8±4.9 days, p=0.943) were also equally distributed between these matched cohorts.

Conclusions: Central arterial cannulation allowed a straightforward surgical repair of TAAD and achieved similar early outcomes to those of peripheral arterial cannulation.