title: Axillary Versus Femoral Arterial Cannulation During Repair of Type A Aortic Dissection?: An Old Problem Seeking New Solutions.
abstract: BACKGROUND
  The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation.
  
  
  METHODS
  A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n= 107) or femoral (n= 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality, and Cox regression hazard ratios were calculated to determine predictors of long-term mortality.
  
  
  RESULTS
  Operative mortality was not influenced by cannulation site (16% for axillary cannulation vs. 19% for femoral cannulation, p = 0.64). In multivariate logistic regression analysis, hemodynamic instability (p < 0.001) and prolonged cardiopulmonary bypass time (>200 min; p = 0.05) emerged as independent predictors of operative mortality. Stroke rates were comparable between the two techniques (14% for axillary and 17% for femoral cannulation, p = 0.52). Five-year actuarial survival was comparable between the groups (55.1% for axillary and 65.7% for femoral cannulation, p = 0.36). In Cox regression analysis, predictors of long-term mortality were: age (p < 0.001), stroke (p < 0.001), prolonged cardiopulmonary bypass time (p = 0.001), hemodynamic instability (p = 0.002), and renal failure (p = 0.001).
  
  
  CONCLUSIONS
  The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles.
authors.affiliation: Department of Cardiovascular Surgery, Baystate Medical Center, Springfield, Massachusetts, USA.
authors.forename: Sotiris C
authors.initials: SC
authors.lastname: Stamou
authors.affiliation: Department of Cardiovascular Surgery, Baystate Medical Center, Springfield, Massachusetts, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Gartner
authors.affiliation: Division of Cardiothoracic Surgery, Missouri Baptist Medical Center, Saint Louis, Missouri, USA.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina, USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Lobdell
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Kamal
authors.initials: K
authors.lastname: Khabbaz
authors.affiliation: Thoracic and Cardiovascular Surgery, Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute, Grand Rapids, Michigan, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Murphy
authors.affiliation: Department of Cardiac Surgery, Hartford Hospital, Hartford, Connecticut, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hagberg
keywords: Aorta; Aortic dissection; Axillary cannulation; Dissection; Femoral cammulation; Outcomes