Femoral artery cannulation increases the risk of postoperative stroke in patients with acute DeBakey I aortic dissection

Xiaomeng Wang; Nan Liu; Hong Wang; Yongmin Liu; Lizhong Sun; Junming Zhu; Xiaotong Hou

doi:10.1016/j.jtcvs.2021.12.049

Femoral artery cannulation increases the risk of postoperative stroke in patients with acute DeBakey I aortic dissection

J Thorac Cardiovasc Surg. 2023 Oct;166(4):1023-1031.e15. doi: 10.1016/j.jtcvs.2021.12.049. Epub 2022 Jan 14.

Authors

Xiaomeng Wang¹, Nan Liu¹, Hong Wang¹, Yongmin Liu², Lizhong Sun², Junming Zhu³, Xiaotong Hou⁴

Affiliations

¹ Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
² Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
³ Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address: anzhenzjm@ccmu.edu.cn.
⁴ Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address: xt.hou@ccmu.edu.cn.

PMID: 35153061
DOI: 10.1016/j.jtcvs.2021.12.049

Abstract

Background: The selection of different arterial cannulation site influences the incidence of postoperative stroke in patients with DeBakey I acute aortic dissection. The study aimed to explore the optimal arterial cannulation for these patients.

Methods: From January 2009 to 2019, a total of 1514 patients with DeBakey I acute aortic dissection underwent frozen elephant trunk and total arch replacement at a tertiary center. They were divided into 2 groups: the axillary artery only cannulation group (n = 1075) and the femoral artery cannulation group (n = 439). After balancing the differences of baseline condition by propensity score matching, the prognosis was compared.

Results: The incidence of stroke and acute brain infarction in the femoral artery cannulation group was higher than in the axillary artery only cannulation group (stroke, 11.7% vs 7.0%, P = .03; acute brain infarction, 6.0% vs 2.7%, P < .01). The femoral artery cannulation group was further divided into 2 groups: femoral artery only cannulation group (n = 106) and axillary combined with femoral artery cannulation group (n = 333). The comparison was performed between the axillary combined with femoral artery cannulation group and the axillary artery only cannulation group. After propensity score matching, the incidence of stroke and acute brain infarction in the axillary combined with femoral artery cannulation group was higher than in the axillary artery only cannulation group (stroke, 13.5% vs 7.2%, P < .01; acute brain infarction, 6.9% vs 2.5%, P < .01).

Conclusions: Axillary artery only cannulation is recommended as the optimal arterial cannulation strategy for most patients with DeBakey I acute aortic dissection. For those patients who are not suitable for axillary artery only cannulation, axillary combined with femoral artery cannulation is not recommended.

Keywords: acute DeBakey I aortic dissection; cerebral protection; optimal arterial cannulation site; stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aortic Dissection* / diagnostic imaging
Aortic Dissection* / epidemiology
Aortic Dissection* / surgery
Axillary Artery
Catheterization / adverse effects
Femoral Artery / surgery
Humans
Retrospective Studies
Stroke* / epidemiology
Stroke* / etiology