Femoral cannulation is safe for type A dissection repair.
BACKGROUND
Recently, surgeons have embraced axillary artery cannulation for type A aortic dissection repair out of concern for malperfusion phenomena with traditional femoral artery cannulation. My colleagues and I sought to determine whether these concerns are justified.


METHODS
Records of 86 consecutive patients (51 men and 35 women; age, 30 to 86 years; mean, 62 years) undergoing surgical repair for acute type A dissection were reviewed. Cannulation site, specific operative repair, and complications related to cannulation were noted.


RESULTS
Seventy-nine cannulations were performed in the femoral artery (47 left, 23 right, and 9 unspecified), 3 in the axillary artery (1 left and 2 right), and 4 in the ascending aorta or arch. Deep hypothermic arrest was used in 64 operations. Seven involved re-sternotomy. Seventy patients had supracoronary grafts (2 with valve replacement and 10 with valve resuspension), and 16 underwent aortic root replacement. Fourteen patients were in shock from cardiac tamponade. Eighty patients survived the operation, and 71 were hospital survivors. Malperfusion on initiation of cardiopulmonary bypass was noted in 3 patients. In 1, the original cannulation site was the ascending aorta, and the cannula was moved to the femoral artery for correction. In 2, the original cannulation site was the femoral artery, and the cannula was moved to the ascending aorta. Malperfusion on clamping of the aorta or on resumption of aortic flow was noted in no patient. Postoperative ischemia of any vascular bed was noted locally only in 3 (cannulated) lower extremities.


CONCLUSIONS
Straight femoral cannulation for all phases of type A dissection repair is appropriate and yields excellent clinical results. The anticipated malperfusion events are actually rare (2 of 79 with femoral artery cannulation, or 2.5%).
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Daniel S
DS
Fusco
Richard K
RK
Shaw
Maryann
M
Tranquilli
Gary S
GS
Kopf
John A
JA
Elefteriades
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001011:Aorta; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001366:Axillary Artery; D019917:Blood Vessel Prosthesis Implantation; D002305:Cardiac Tamponade / Q000209:etiology; D002404:Catheterization / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality; D007511:Ischemia / Q000209:etiology; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome