title: Subclavian artery cannulation provides superior outcomes in patients with acute type-A dissection: long-term results of 290 consecutive patients.
abstract: OBJECTIVE
  The short-term results of subclavian artery cannulation (SC) for acute type-A dissection repair have been reported to be superior in regard to mortality and neurological outcomes when compared to femoral cannulation (FC). This study evaluates the long-term results of subclavian artery cannulation versus femoral cannulation for repair of acute type-A dissection with particular regard to neurological deficits, mortality and the need for re-operations.
  
  
  METHODS
  From 1992-2005, 346 patients underwent surgical repair of acute type-A dissection of which 290 patients survived the operation. SC was performed in 114 patients and FC in 176 patients. Follow-up (FU) was completed in 89.5% (n = 259) and the medium FU-period was 42 months (SC) and 69 months (FC). Endpoints were persistence of neurological-deficits, mortality, major complications and necessity for re-operations.
  
  
  RESULTS
  Overall survival and disease-free survival at 5 years were significantly higher in the SC group (83% vs. 71%; p = 0.022 and 74% vs. 61%; p = 0.044). Freedom of re-operation also appeared to be higher in the SC group (89% vs. 79%; p = 0.125). During the follow-up period, 28 patients (11/114 vs. 17/176; p = 0.58) suffered from neurological deficits of which 16 patients had permanent neurological-deficits at the 5 year follow-up. Of these patients, significantly more belonged to the FC group indicating an improved neurological-outcome for the SC group (3/11 vs. 13/17; p = 0.019).
  
  
  CONCLUSIONS
  This study demonstrates excellent long-term outcomes after emergency surgery for acute type-A dissection. Subclavian artery perfusion represents an excellent approach to repair acute type-A dissection. Beside a significantly reduced long-term mortality, this technique provides an improved neurological outcome and a higher disease-free survival-rate.
authors.affiliation: City Hospital âTriemliâ Clinic for Cardiac Surgery Zürich, Switzerland; Ulrich.Schurr@bluewin.ch.
authors.forename: Ulrich P F
authors.initials: UP
authors.lastname: Schurr
authors.forename: Maximilian Y
authors.initials: MY
authors.lastname: Emmert
authors.forename: Denis
authors.initials: D
authors.lastname: Berdajs
authors.forename: Oliver
authors.initials: O
authors.lastname: Reuthebuch
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Omer
authors.initials: O
authors.lastname: Dzemali
authors.forename: Michele
authors.initials: M
authors.lastname: Genoni
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D002404:Catheterization / Q000379:methods*; D015331:Cohort Studies; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013348:Subclavian Artery; D016896:Treatment Outcome; D055815:Young Adult