The best strategy of arterial cannulation during aortic arch replacement is still debated. We reported our experience with the Axillary and Femoral artery cannulation, comparing the incidence of major neurological events and in-hospital mortality.
Between 1996 and 2016, 938 consecutive patients (pts) underwent arch replacement in our center. We included only two groups of patients, according to the type of arterial cannulation: Axillary group with 282 pts and Femoral group with 409 pts. Baseline characteristics of the patients are reported in Table 1.
The hemiarch replacement was performed more often in Femoral group (57.2% vs 38.3%, p = .001). The Femoral cannulation was the most commonly used in urgent/emergent cases (56% vs 36.9%, p = .001). Cardiopulmonary bypass time (Axillary: 216.08 ± 61.47 vs Femoral: 203.78 ± 63.69; p = .001), Cross-Clamp Time (141.12 ± 47.5 vs 132.71 ± 49.10; p = .016), Circulatory Arrest Time (2.51 ± 1.74 vs 4.26 ± 2.49; p = .001) and antegrade selective cerebral perfusion time (69.19 ± 34.46 vs 58.84 ± 34.94; p = .001) were longer in Axillary group. Hospital mortality was similar between the two groups (12.1% vs 13.9%, p = .546) as well as for permanent neurological deficit (6.7% vs 7.3%, p = .881). Transient neurological deficit is significantly higher in the Axillary group (17.4% vs 11.0%, p = .022).
Our study confirms that Axillary and Femoral artery cannulations were associated with similar outcomes after aortic arch surgery. The Axillary cannulation was used more frequently in complex repair of the aortic arch, while the Femoral can be still considered a viable option, especially in urgent/emergent cases.
1Cardiochirurgia-S.Orsola-Università di Bologna Bologna