Axillary vs Femoral Arterial Cannulation in Acute Type A Dissection: International Multicenter Data

BACKGROUND Cannulation strategy in acute Type A dissection (ATAD) varies widely without known gold standards. We compared ATAD outcomes of Axillary versus Femoral cannulation in a large cohort from the International Registry of Acute Aortic Dissection (IRAD). METHODS We retrospectively reviewed 2145 IRAD Interventional Cohort patients (1996-2021) undergoing ATAD repair with axillary or femoral cannulation (Axillary: N=1106, 52%; Femoral: N=1039, 48%). Endpoints included: early mortality; neurologic, respiratory and renal complications; malperfusion; and tamponade. All outcomes are presented as axillary with respect to femoral. RESULTS The proportion of patients under age 70 in both groups was similar (N=1577, 74%) as were: bicuspid aortic valve, Marfan syndrome, and previous dissection. Femoral patients had slightly more aortic insufficiency [408 (55%) vs 429 (60%) p=0.058] and coronary involvement [48 (8%) vs 70 (13%) p=0.022]. Axillary patients underwent more total arch [156 (15%) vs 106 (11%) p=0.02] and valve-sparing root replacements [220 (22%) vs 112 (12%) p<0.001]. More Femoral patients underwent commissural resuspension [269 (30.9%) vs 324 (35.3%) p=0.05]. Valve replacement rates were not different. Mean duration of cardiopulmonary bypass was longer among Femoral patients [190 (150-237) vs 200 (160-249) mins p=0.002].In-hospital mortality was similar between Axillary (N=165, 15%) and Femoral (N=149, 14%) patients (p=0.7). Furthermore, there were no differences in stroke, visceral ischemia, tamponade, respiratory insufficiency, coma, or spinal cord ischemia. CONCLUSIONS Axillary cannulation is associated with more stable ATAD presentation, but more extensive intervention compared to Femoral. Both have equivalent early mortality, stroke, tamponade, and malperfusion outcomes after statistical adjustment.