Key result
Axillary cannulation was associated with reduced short-term mortality compared to femoral cannulation (OR 0.42; 95% CI 0.25-0.70; p=0.0009) in acute type A aortic dissection surgery.
Why the study?
Consensus regarding the best cannulation strategy in type A aortic dissection surgery remains controversial despite interest in axillary cannulation.
Does axillary cannulation reduce short-term mortality and neurological events compared to femoral cannulation in patients undergoing emergency surgery for acute type A aortic dissection?
Meta-Analysis (n=2,621)
Does axillary cannulation reduce short-term mortality and neurological events compared to femoral cannulation in patients undergoing emergency surgery for acute type A aortic dissection?
Odds Ratio: 0.42 (95% CI 0.25–0.7)
p-value: p=0.0009
In patients undergoing surgery for acute type A aortic dissection, axillary cannulation is associated with significantly lower short-term mortality and neurological events compared to femoral cannulation.
Supports preferring axillary cannulation in acute type A aortic dissection repair; extends meta-analytic evidence for lower mortality.
Objective There has been a growing interest in antegrade cannulation techniques in type A aortic dissection surgery. Axillary cannulation has previously been reported to provide better outcomes in terms of short-term mortality and neurological event. Consensus regarding the best cannulation strategy still remains controversial. Method The MEDLINE and EMBASE databases were conducted up until October 3, 2020. Data regarding mortality, stroke, reoperation for bleeding and length of hospital stay, wound infection and cardiopulmonary bypass time were extracted and submitted to a meta-analysis using random-effects modelling and the I2-test for heterogeneity. Fourteen retrospective observational studies were included, enrolling a total of 2621 patients. Results There were a total of 2621 patients (1327 axillary cannulation and 874 femoral cannulation). Axillary cannulation was associated with reduced short term mortality (pooled odds ratio [OR] = +0.42, 95% confidence interval [CI] = +0.25 to +0.70; p = .0009) compared to femoral cannulation. Axillary cannulation was also associated with a lower incidence of neurological events (pooled OR = +0.63, 95% CI = +0.42 to +0.94; p = .02). Conclusion Our meta-analyses suggests that axillary cannulation has superior outcomes in terms of mortality and stroke following emergency surgery for type A aortic dissection. However, the lack of high quality randomized controlled trials does not make this recommendation generalisable to all units.
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Hussain et al. (2021) conducted a meta-analysis in Acute type A aortic dissections (n=2,621). Axillary cannulation vs. Femoral cannulation was evaluated on Short-term mortality (OR 0.42, 95% CI 0.25-0.70, p=0.0009). Axillary cannulation was associated with reduced short-term mortality compared to femoral cannulation (OR 0.42; 95% CI 0.25-0.70; p=0.0009) in acute type A aortic dissection surgery.
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