Right axillary artery cannulation in acute type A aortic dissection with involvement of the right axillary artery
Abstract
Objective
Right axillary artery is currently recommended for arterial cannulation in surgery for acute type A aortic dissection. However, the feasibility of cannulation on a dissected right axillary artery remains undetermined. The objective was to examine the feasibility of cannulation on a dissected right axillary artery.
Methods
From 2016 to 2020, 835 patients who underwent acute type A aortic dissection repair were included in this study. Cannulation strategy and perioperative outcomes of patients who did and did not have right axillary artery dissection were compared. Propensity score matching and logistic regression were applied.
Results
124 Patients was with right axillary artery dissection and 711 patients were not. Direct right axillary artery cannulation was used for cardiopulmonary bypass in the majority of patients, but with lower rate in patients with right axillary artery dissection (n=88 [71.0%] vs n=579 [81.4%], p=0.007). Right axillary artery cannulation failure (n=3 [2.4%] vs n=5 [0.7%], p=0.102) and related complications (n=1 [0.8%] vs n=6[0.8%], p=1.000) were rare in both groups. In-hospital mortality (n=18 [14.5%] vs. n=59 [8.3%], p=0.027) and stroke (n=14 [11.3%] vs n=42 [5.9%], p=0.027) were significantly higher in the right axillary artery dissection group. But after propensity score matching, in-hospital outcomes were comparable. Right axillary artery dissection was not a risk factor for mortality, stroke, right axillary artery cannulation not performed or right axillary artery cannulation failure.
Conclusions
Direct right axillary artery cannulation is feasible for most acute type A aortic dissection patients with right axillary artery dissection.