title: The impact of arterial cannulation strategy on operative outcomes in aortic surgery: evidence from a comprehensive meta-analysis of comparative studies on 4476 patients.
abstract: OBJECTIVE
  There is a growing perception that peripheral cannulation through the femoral artery, by reversing the flow in the thoracoabdominal aorta, may increase the risk of retrograde brain embolization in aortic surgery. Central cannulation sites, including the right axillary artery, have been reported to improve operative outcomes by allowing antegrade blood flow. However, peripheral cannulation still remains largely used because a consensus for the routine use of central cannulation approaches has not been reached.
  
  
  METHODS
  A meta-analysis of comparative studies reporting operative outcomes using central cannulation versus peripheral cannulation was performed. Pooled weighted incidence rates for end points of interest were obtained using an inverse variance model.
  
  
  RESULTS
  A total of 4476 patients were included in the final analysis. Central cannulation was used in 2797 patients, and peripheral cannulation was used in 1679 patients. Central cannulation showed a protective effect on in-hospital mortality (risk ratio, 0.59; 95% confidence interval, 0.48-0.7; P < .001) and permanent neurologic deficit (risk ratio, 0.71; 95% confidence interval, 0.55-0.90; P = .005) when compared with peripheral cannulation. A trend toward an increased benefit in terms of reduced in-hospital mortality was observed when only the right axillary artery was used as the central cannulation approach (risk ratio, 0.35; 95% confidence interval, 0.22-0.55; P < .001; I(2) = 0%).
  
  
  CONCLUSIONS
  Central cannulation was superior to peripheral cannulation in reducing in-hospital mortality and the incidence of permanent neurologic deficit. This superiority was particularly evident when the axillary artery was used for central cannulation.
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom. Electronic address: umberto.benedetto@hotmail.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: John R
authors.initials: JR
authors.lastname: Pepper
authors.affiliation: Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zeinah
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors.forename: Euclide
authors.initials: E
authors.lastname: Tonelli
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
mesh_terms: D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001366:Axillary Artery / Q000503:physiopathology*; D002404:Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D017052:Hospital Mortality; D006801:Humans; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control; D064887:Observational Studies as Topic; D016017:Odds Ratio; D065840:Protective Factors; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality