Skip to main content

Advertisement

SpringerLink
Log in

Direct Aortic Versus Supra-Aortic Arterial Cannulation During Surgery for Acute Type A Aortic Dissection

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Aims

In this study we evaluated the impact of direct aortic cannulation versus innominate/subclavian/axillary artery cannulation on the outcome after surgery for type A aortic dissection.

Methods

The outcomes of patients included in a multicenter European registry (ERTAAD) who underwent surgery for acute type A aortic dissection with direct aortic cannulation versus those with innominate/subclavian/axillary artery cannulation, i.e. supra-aortic arterial cannulation, were compared using propensity score matched analysis.

Results

Out of 3902 consecutive patients included in the registry, 2478 (63.5%) patients were eligible for this analysis. Direct aortic cannulation was performed in 627 (25.3%) patients, while supra-aortic arterial cannulation in 1851 (74.7%) patients. Propensity score matching yielded 614 pairs of patients. Among them, patients who underwent surgery for TAAD with direct aortic cannulation had significantly decreased in-hospital mortality (12.7% vs. 18.1%, p = 0.009) compared to those who had supra-aortic arterial cannulation. Furthermore, direct aortic cannulation was associated with decreased postoperative rates of paraparesis/paraplegia (2.0 vs. 6.0%, p < 0.0001), mesenteric ischemia (1.8 vs. 5.1%, p = 0.002), sepsis (7.0 vs. 14.2%, p < 0.0001), heart failure (11.2 vs. 15.2%, p = 0.043), and major lower limb amputation (0 vs. 1.0%, p = 0.031). Direct aortic cannulation showed a trend toward decreased risk of postoperative dialysis (10.1 vs. 13.7%, p = 0.051).

Conclusions

This multicenter cohort study showed that direct aortic cannulation compared to supra-aortic arterial cannulation is associated with a significant reduction of the risk of in-hospital mortality after surgery for acute type A aortic dissection.

Trial registration

ClinicalTrials.gov Identifier: NCT04831073.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Harris KM, Nienaber CA, Peterson MD et al (2022) Early mortality in type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. JAMA Cardiol 7:1009–1015

    Article  PubMed  PubMed Central  Google Scholar 

  2. Isselbacher EM, Preventza O, Black JH et al (2022) ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 146:e334–e482

    Article  PubMed  Google Scholar 

  3. Ghoreishi M, Sundt TM, Cameron DE et al (2020) Factors associated with acute stroke after type A aortic dissection repair: an analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg 159:2143-2154.e3

    Article  PubMed  Google Scholar 

  4. Rosinski BF, Idrees JJ, Roselli EE et al (2019) Cannulation strategies in acute type A dissection repair: a systematic axillary artery approach. J Thorac Cardiovasc Surg 158:647–659

    Article  PubMed  Google Scholar 

  5. Helder MRK, Schaff H, Day CN et al (2020) Regional and temporal trends in the outcomes of repairs for acute type A aortic dissections. Ann Thorac Surg 109:26–33

    Article  PubMed  Google Scholar 

  6. Kreibich M, Chen Z, Rylski B et al (2019) Outcome after aortic, axillary, or femoral cannulation for acute type A aortic dissection. J Thorac Cardiovasc Surg 158:27–34

    Article  PubMed  Google Scholar 

  7. Jormalainen M, Raivio P, Mustonen C et al (2020) Direct aortic versus peripheral arterial cannulation in surgery for type A aortic dissection. Ann Thorac Surg 110:1251–1258

    Article  PubMed  Google Scholar 

  8. Malaisrie SC, Szeto WY, Halas M et al (2021) 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg 162:735–758

    Article  PubMed  Google Scholar 

  9. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349

    Article  Google Scholar 

  10. Biancari F, Mariscalco G, Yusuff H et al (2021) European registry of type A aortic dissection (ERTAAD)—rationale, design and definition criteria. J Cardiothorac Surg 16:171.

  11. Conzelmann LO, Hoffmann I, Blettner M et al (2012) Analysis of risk factors for neurological dysfunction in patients with acute aortic dissection type A: data from the German Registry for Acute Aortic Dissection type A (GERAADA). Eur J Cardiothorac Surg 42:557–565

    Article  PubMed  Google Scholar 

  12. Conzelmann LO, Weigang E, Mehlhorn U et al (2016) Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 49:e44-52

    Article  PubMed  Google Scholar 

  13. Gudbjartsson T, Ahlsson A, Geirsson A et al (2019) Acute type A aortic dissection—review. Scand Cardiovasc J 54:1–13

    Article  PubMed  Google Scholar 

  14. Svensson LG, Blackstone EH, Rajeswaran J et al (2004) Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg 78:1274–1284

    Article  PubMed  Google Scholar 

  15. de Paulis R, Czerny M, Weltert L et al (2015) Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe. Eur J Cardiothorac Surg 47:917–923

    Article  PubMed  Google Scholar 

  16. Schachner T, Nagiller J, Zimmer A, Laufer G, Bonatti J (2005) Technical problems and complications of axillary artery cannulation. Eur J Cardiothorac Surg 27:634–637

    Article  PubMed  Google Scholar 

  17. Borst HG, Laas J, Heinemann M (1991) Type A aortic dissection: diagnosis and management of malperfusion phenomena. Semin Thorac Cardiovasc Surg 3:238–241

    CAS  PubMed  Google Scholar 

  18. Jakob H, Tsagakis K, Szabo A, Wiese I, Thielmann M, Herold U (2007) Rapid and safe direct cannulation of the true lumen of the ascending aorta in acute type A aortic dissection. J Thorac Cardiovasc Surg 134:244–245

    Article  PubMed  Google Scholar 

  19. Khaladj N, Shrestha M, Peterss S et al (2008) Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience. Eur J Cardiothorac Surg 34:792–796

    Article  PubMed  Google Scholar 

  20. Reece TB, Tribble CG, Smith RL et al (2007) Central cannulation is safe in acute aortic dissection repair. J Thorac Cardiovasc Surg 133:428–434

    Article  PubMed  Google Scholar 

  21. Kamiya H, Kallenbach K, Halmer D et al (2009) Comparison of ascending aorta versus femoral artery cannulation for acute aortic dissection type A. Circulation 120(11 Suppl):S282–S286

    PubMed  Google Scholar 

  22. Khoynezhad A, Plestis KA (2006) Cannulation in the diseased aorta: a safe approach using the Seldinger technique. Tex Heart Inst J 33:353–355

    PubMed  PubMed Central  Google Scholar 

  23. Shimura S, Odagiri S, Furuya H et al (2020) Echocardiography-guided aortic cannulation by the Seldinger technique for type A dissection with cerebral malperfusion. J Thorac Cardiovasc Surg 159:784–793

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by the Finnish Foundation for Cardiovascular Research and the Sigrid Juselius Foundation.

Author information

Authors and Affiliations

  1. Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland

    Tatu Juvonen, Mikko Jormalainen, Caius Mustonen, Peter Raivio & Fausto Biancari

  2. Anesthesia and Critical Care, Research Unit of Surgery, University of Oulu, Oulu, Finland

    Tatu Juvonen

  3. Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany

    Till Demal & Lenard Conradi

  4. Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France

    Antonio Fiore & Thierry Folliguet

  5. Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France

    Andrea Perrotti & Amélie Hervé

  6. Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy

    Enzo Mazzaro & Giuseppe Gatti

  7. Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium

    Matteo Pettinari

  8. LMU University Hospital, Ludwig Maximilian University, Munich, Germany

    Sven Peterss & Joscha Buech

  9. German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany

    Joscha Buech

  10. Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France

    Francesco Nappi

  11. Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain

    Angel G. Pinto & Javier Rodriguez Lega

  12. Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic

    Marek Pol & Petr Kacer

  13. Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany

    Angelo M. Dell’Aquila, Andreas Rukosujew & Konrad Wisniewski

  14. Cardiothoracic Department, University Hospital, Udine, Italy

    Igor Vendramin & Daniela Piani

  15. Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy

    Luisa Ferrante & Mauro Rinaldi

  16. Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain

    Eduard Quintana & Robert Pruna-Guillen

  17. Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France

    Sebastien Gerelli & Dario Di Perna

  18. Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK

    Metesh Acharya & Giovanni Mariscalco

  19. Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK

    Mark Field & Manoj Kuduvalli

  20. Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy

    Francesco Onorati & Cecilia Rossetti

  21. Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland

    Timo Mäkikallio & Fausto Biancari

Authors
  1. Tatu Juvonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mikko Jormalainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caius Mustonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Till Demal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Fiore
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrea Perrotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Amélie Hervé
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Enzo Mazzaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giuseppe Gatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Matteo Pettinari
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sven Peterss
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Joscha Buech
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Francesco Nappi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Lenard Conradi
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Angel G. Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Javier Rodriguez Lega
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Marek Pol
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Petr Kacer
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Angelo M. Dell’Aquila
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Andreas Rukosujew
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Konrad Wisniewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Igor Vendramin
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Daniela Piani
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Luisa Ferrante
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Mauro Rinaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Eduard Quintana
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Robert Pruna-Guillen
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Sebastien Gerelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Dario Di Perna
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Thierry Folliguet
    View author publications

    You can also search for this author in PubMed Google Scholar

  31. Metesh Acharya
    View author publications

    You can also search for this author in PubMed Google Scholar

  32. Mark Field
    View author publications

    You can also search for this author in PubMed Google Scholar

  33. Manoj Kuduvalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  34. Francesco Onorati
    View author publications

    You can also search for this author in PubMed Google Scholar

  35. Cecilia Rossetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  36. Timo Mäkikallio
    View author publications

    You can also search for this author in PubMed Google Scholar

  37. Peter Raivio
    View author publications

    You can also search for this author in PubMed Google Scholar

  38. Giovanni Mariscalco
    View author publications

    You can also search for this author in PubMed Google Scholar

  39. Fausto Biancari
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The authors confirm contribution to the paper as follows: Study conception and design: TJ, MJ, CM, TM, FB. Data collection: TJ, MJ, CM, TD, AF, AP, AH, EM, GG, MP, SP, JB, FN, LC, AGP, JRL, MP, PK, AMDA, AR, KW, IV, DP, LF, MR, EQ, RPG, SG, DDP, TF, MA, MF, MK, FO, CR, TM, PR, GM, FB. Analysis and interpretation of results: FB, TJ. Draft manuscript preparation: TJ, MJ, CM, TM, FB. Review of the draft manuscript: TJ, MJ, CM, TD, AF, AP, AH, EM, GG, MP, SP, JB, FN, LC, AGP, JRL, MP, PK, AMDA, AR, KW, IV, DP, LF, MR, EQ, RPG, SG, DDP, TF, MA, MF, MK, FO, CR, TM, PR, GM, FB. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Fausto Biancari.

Ethics declarations

Conflict of interest

None declared.

Informed Consent

Informed consent was not obtained from the individual participants included in the study.

Statement of Human Rights

The Ethical Review Board of the Helsinki University Hospital, Finland (April 21, 2021, diary no. HUS/237/2021) and the Ethical Review Board of each participating hospital approved this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Juvonen, T., Jormalainen, M., Mustonen, C. et al. Direct Aortic Versus Supra-Aortic Arterial Cannulation During Surgery for Acute Type A Aortic Dissection. World J Surg 47, 2899–2908 (2023). https://doi.org/10.1007/s00268-023-07116-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-023-07116-z

Search

Navigation