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

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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.


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.


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).


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 Identifier: NCT04831073.

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

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Authors and Affiliations



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.

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Correspondence to Fausto Biancari.

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None declared.

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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.

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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).

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