The central cannulation technique was introduced at our institution in 2018 and has evolved into a primary cannulation strategy for acute type A aortic dissection (ATAAD) surgery. This study aimed to compare the clinical outcomes of central aortic cannulation with those of conventional axillary arterial cannulation.

Between January 2005 and September 2024, 586 patients who underwent aortic repair for ATAAD were retrospectively reviewed. The clinical outcomes of the patients who underwent central cannulation were compared with those of the patients who underwent axillary cannulation. Propensity score matching was used to compare 189 patients in each group.

Central cannulation was associated with a significantly shorter total operative time (280.14 min vs 321.20 min, P < .001) and achieved significantly lower early mortality than the axillary cannulation group (3.7% vs 9.5%, P = .037), respectively. The rates of major postoperative complications, including cerebrovascular events and hospital course indicators, were comparable between groups. The mean follow-up duration was 42.77 months, and Kaplan-Meier analysis revealed no statistically significant difference in long-term overall survival between the groups. The most frequently selected central cannulation site was the lesser curvature of the aortic arch, accounting for 43.4% of cases.

Central cannulation significantly reduced operative duration compared with axillary cannulation. Early mortality was lower in the central cannulation group. The rates of significant neurological dysfunction and procedure-related complications were comparable with those associated with axillary cannulation. Central cannulation can be safely and effectively used as a primary cannulation strategy for ATAAD.