Page 227 - Read Online

Somers et al. Vessel Plus 2024;8:15 Vessel Plus
DOI: 10.20517/2574-1209.2023.48

Original Article Open Access

Direct aortic cannulation, a safe alternative to

femoral artery cannulation - 17 years of type A
dissection surgery experience

Tim Somers , Wilson W. L. Li, Jochem Jongenotter, Michel W. A. Verkroost, Ad F. T. M. Verhagen,
Wim J. Morshuis, Tim Smith, Guillaume S. C. Geuzebroek, Robin H. Heijmen
Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen 6525GA, The Netherlands.

Correspondence to: Dr. Tim Somers, Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert
Grooteplein Zuid 10, Nijmegen 6525GA, The Netherlands. E-mail: tim.somers@radboudumc.nl

How to cite this article: Somers T, Li WWL, Jongenotter J, Verkroost MWA, Verhagen AFTM, Morshuis WJ, Smith T,
Geuzebroek GSC, Heijmen RH. Direct aortic cannulation, a safe alternative to femoral artery cannulation - 17 years of type A
dissection surgery experience. Vessel Plus 2024;8:15. https://dx.doi.org/10.20517/2574-1209.2023.48
Received: 31 May 2023 First Decision: 9 Jan 2024 Revised: 5 Feb 2024 Accepted: 13 Mar 2024 Published: 21 Mar 2024

Academic Editors: Frank W. Sellke, Cristiano Spadaccio Copy Editor: Fangyuan Liu Production Editor: Fangyuan Liu

Abstract
Aim: Optimal cannulation strategy for acute type A aortic dissection (ATAAD) surgery remains debated. Recent
guidelines have advocated antegrade systemic perfusion through right axillary artery (RAX) cannulation, instead of
femoral artery (FA) cannulation. However, RAX cannulation can be technically challenging and time-consuming.
On the other hand, direct (ascending) aorta (DA) cannulation is a swift procedure that also ensures downstream
antegrade flow. In this regard, we assessed whether DA cannulation is a safe alternative to FA cannulation.

Methods: Records of all patients undergoing ATAAD surgery between 2006-2022 at the Radboud University
Medical Center were retrospectively reviewed.

Results: In total, 281 patients underwent surgery for ATAAD during the investigated period. Three patients were
excluded due to death before the start of extracorporeal circulation and four because of RAX cannulation. Of the
remaining 274 patients, 53% (N = 145) received primary FA and 47% (N = 129) DA cannulation, with a success
rate of 98% for both approaches. Surgical mortality (combined in-hospital and 30-day) was 9.9%
(7.8% DA group vs. 11.7% FA group, P = 0.271). New permanent neurological damage was seen in 10.9% vs. 6.9%
(P = 0.248), respectively. In multivariate analysis, cannulation strategies were not significantly associated with
surgical mortality nor postoperative new permanent neurological damage.

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.oaepublish.com/vp