Key result
Antegrade arterial cannulation during type A aortic dissection surgery was associated with 8% mortality and 0% transient neurologic dysfunction, compared to 12% and 16% with retrograde cannulation.
Why the study?
The study evaluated the impact of retrograde versus antegrade cannulation strategies on outcomes of type A aortic dissection surgery and sought to identify predictors of perioperative neurologic dysfunction.
Does antegrade arterial cannulation improve hospital outcomes and reduce neurologic dysfunction compared to retrograde cannulation in patients undergoing surgical repair of type A aortic dissection?
Cohort (n=50)
No
Does antegrade arterial cannulation improve hospital outcomes and reduce neurologic dysfunction compared to retrograde cannulation in patients undergoing surgical repair of type A aortic dissection?
Absolute Event Rate: 8% vs 12%
Antegrade cannulation during type A aortic dissection repair may be associated with lower rates of transient neurologic dysfunction compared to retrograde cannulation, though larger studies are needed.
May favor antegrade cannulation to reduce neurologic dysfunction in type A dissection repair; leaves open confirmation in randomized trials.
Background the aim of our study was to evaluate the impact of different cannulation strategies, retrograde and antegrade, on outcome of type A aortic dissection (TAAD) surgery and to identify the predictors of perioperative transient & permanent neurologic dysfunction. Methods Between March 2014 and September 2017, 50 patients with TAAD who underwent surgical repair of aortic dissection at Kasr Alainy Hospital, Cardiothoracic Surgery Department were divided into two equal groups: The first group had retrograde (femoral) cannulation, while the second group had antegrade cannulation (central, right axillary, and innominate artery). Results the mean age was 52.6 ± 7.55 years in the retrograde group and 46.5 ± 10.53 years in the antegrade group. There were 3 deaths in the retrograde group (12%) and 2 deaths in the antegrade group (8%). Transient neurologic dysfunction was observed in 4 patients (16%) in the first group and 0 patients (0%) in the second group. A total of 3 patients (12%) in the first group suffered from a permanent neurologic dysfunction to 2 patients (8%) in the second group. Conclusions The cannulation site in an aortic dissection should be carefully chosen on a case-by-case basis and larger study is recommended to better evaluate optimal cannulation technique.
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Soliman et al. (2018) conducted a cohort in Type A aortic dissection (n=50). Antegrade cannulation vs. Retrograde (femoral) cannulation was evaluated on Mortality. Antegrade arterial cannulation during type A aortic dissection surgery was associated with 8% mortality and 0% transient neurologic dysfunction, compared to 12% and 16% with retrograde cannulation.
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