title: Which cannulation (axillary cannulation or femoral cannulation) is better for acute type A aortic dissection repair? A meta-analysis of nine clinical studies.
abstract: There is a trend towards using the axillary artery cannulation (AXC) site for cardiopulmonary bypass surgery in patients requiring acute type A aortic dissection (AAD) repair. However, AXC has not been established as a routine procedure, because there is controversy about its clinical advantage when compared with femoral artery cannulation (FAC). This meta-analysis assesses major short-term outcomes in patients undergoing acute AAD repair with AXC or FAC using non-randomized retrospective studies dating from 1992 to 2011 comparing AXC and FAC for major outcomes. Outcomes of interest were short-term mortality, neurological dysfunction and malperfusion. The fixed-effects model was used. Sensitivity and heterogeneity were analysed. Analysis of nine non-randomized studies comprising 715 patients [AXC, 359 (50.2%) and FAC, 356 (49.8%)] showed a significantly lower incidence of short-term mortality in the AXC group [odds ratio, 0.25, 95% confidence interval (CI) (0.15, 0.42), χ(2) = 7.23, P < 0.01]. The pattern of incidence of neurological dysfunction among the AXC group [odds ratio, 0.46, 95% CI (0.29, 0.72), χ(2) = 9.01, P < 0.01] was similar. The incidence of malperfusion did not differ [odds ratio, 0.84, 95% CI (0.37, 1.90), χ(2) = 2.25, P = 0.67]. Because no study was a randomized trial, our results are more uncertain than indicated by the 95% CI. Nevertheless, AXC seems to give better short-term mortality and neurological dysfunction rates than FAC.
authors.affiliation: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Zongli
authors.initials: Z
authors.lastname: Ren
authors.affiliation: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China wangzhiwp@gmail.com.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Hu
authors.affiliation: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Hongbing
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Hongping
authors.initials: H
authors.lastname: Deng
authors.affiliation: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Hu
authors.affiliation: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Wanli
authors.initials: W
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001366:Axillary Artery / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Axillary artery; Cannulation; Cardiopulmonary bypass; Femoral artery; Subclavian artery; Type A aortic dissection