title: Axillar or Aortic Cannulation for Aortic Repair in Patients With Stanford A Dissection?
abstract: BACKGROUND
  The choice of an optimal cannulation site for aortic repair in patients with Stanford A acute aortic dissection remains controversial. The aim of this study was to compare the early results and long-term outcomes of axillar and direct aortic cannulation.
  
  
  METHODS
  A total of 235 consecutive patients who underwent surgical aortic repair with the use of axillar or direct aortic cannulation from January 2006 to April 2015 were analyzed. The primary end points were long-term overall cumulative survival and freedom from major cerebrovascular events with up to 10 years of follow-up. The secondary end points were early postoperative clinical characteristics and rates of adverse events. To control for confounders, a 1:3 propensity score matching was performed.
  
  
  RESULTS
  After matching, there were no statistically significant differences between the two groups regarding baseline characteristics. Both groups were associated with comparable outcomes; among other things, the length of stay in the intensive care unit (ICU) (p = 0.220), mechanical ventilation (p = 0.177), total hospital stay (p = 0.243), and hospital rates of adverse events. There were no statistically significant differences (p = 0.625) in terms of freedom from major cerebrovascular events. However, both early (p = 0.009) and late (p = 0.016) overall survival were significantly poorer for patients undergoing aortic cannulation.
  
  
  CONCLUSIONS
  The outcomes were comparable regarding early hospital outcomes and rates of adverse events. Whereas postoperative freedom from major cerebrovascular events was similar, survival over long-term follow-up was significantly poorer when direct aortic cannulation was used. More investigations are needed to enable an understanding of the underlying factors for potentially higher late mortality when direct aortic cannulation is used during a surgical procedure for acute Stanford A dissection.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany. Electronic address: a.sabashnikov@gmail.com.
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Heinen
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Antje-Christin
authors.initials: AC
authors.lastname: Deppe
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zeriouh
authors.affiliation: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom.
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Slottosch
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Eghbalzadeh
authors.affiliation: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom.
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Oliver-Johannes
authors.initials: OJ
authors.lastname: Liakopoulos
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Parwis B
authors.initials: PB
authors.lastname: Rahmanian
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Navid
authors.initials: N
authors.lastname: Madershahian
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kroener
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Yeong-Hoon
authors.initials: YH
authors.lastname: Choi
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Kuhn-Régnier
authors.affiliation: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom.
authors.forename: André R
authors.initials: AR
authors.lastname: Simon
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Wippermann
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001366:Axillary Artery; D002404:Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies