Aortic and arch branch vessel cannulation in acute type A aortic dissection repair.

Objective: To evaluate central aortic cannulation and arch branch vessel (ABV) cannulation in acute type A aortic dissection repair.
Methods: From 2015 to April 2020, 298 patients underwent open repair of an acute type A aortic dissection. Patients undergoing femoral cannulation for cardiopulmonary bypass (n = 34) were excluded. Patients were then divided based on initial cannulation for cardiopulmonary bypass into central aortic cannulation (n = 72) and ABV cannulation (n = 192) groups. ABV sites included cannulation of the axillary, innominate, right/left common carotid, and intrathoracic right subclavian arteries.
Results: The aortic cannulation group was younger (59 vs 62 years; P  = .02), more likely to be men (76% vs 60%; P  = .02), and had more peripheral vascular disease (60% vs 37%; P  = .0009). ABV dissection was similar between central and ABV cannulation groups (53% vs 60%; P  = .51). The aortic cannulation group underwent less aggressive arch replacement, had shorter cardiopulmonary bypass times (200 vs 222 minutes; P  = .01), less utilization of antegrade cerebral perfusion (93% vs 98%; P  = .04), and received less blood transfusion (0 vs 1 U; P  = .001). Postoperative outcomes were similar between aortic and ABV cannulation groups, including stroke (5.6% vs 5.2%; P  = 1.0) and operative mortality (4.2% vs 6.3%; P  = .77). In addition, postoperative strokes were similar in location (right-brain, left-brain, or bilateral), etiology (embolic vs hemorrhagic), and presence of permanent deficits. Aortic cannulation was not a risk factor for postoperative stroke (odds ratio, 0.94; P  = .91) or operative mortality (odds ratio, 0.70; P  = .64). Short-term survival was similar between central and ABV cannulation groups.
Conclusions: Both aortic and ABV cannulation were safe and effective cannulation strategies in acute type A aortic dissection repair.
(© 2022 The Author(s).)