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Somers et al. Vessel Plus 2024;8:15 https://dx.doi.org/10.20517/2574-1209.2023.48 Page 5 of 9

Table 1. Baseline and operative characteristics of patients who underwent acute type A aortic dissection surgery
Baseline Femoral cannulation Direct aortic cannulation Total P value
Number (n) 145 (53) 129 (47) 274 (100)
Age, years 62.7 ± 12.6 62.3 ± 12.3 62.5 ± 12.5 0.806
< 40 years 6 (4.1) 6 (4.7) 12 (4.4) 0.836
40-59 years 45 (31) 44 (34) 89 (32) 0.588
60-79 years 87 (60) 72 (56) 159 (58) 0.483
> 80 years 7 (4.8) 7 (5.4) 14 (5.1) 0.822
Female 64 (44) 56 (43) 120 (44) 0.904
Preoperative tamponade 35 (24) 18 (14) 53 (19) 0.033
Preoperative neurological damage 7 (4.8) 8 (6.2) 15 (5.5) 0.618
EuroScore II, % 11.7 ± 10.7 8.1 ± 5.3 10.0 ± 8.6 0.155
Operative covariates Femoral cannulation Direct aortic cannulation Total P value
(n = 145) (n = 129) (n = 274)
Root replacement 44 (30) 55 (43) 99 (36) 0.035
Valve sparing 4 (2.8) 4 (3.1) 8 (2.9) 1.000
Bentall 40 (28) 51 (40) 91 (33) 0.625
0.036
SCAR with cross-clamp 4 (2.8) 5 (3.9) 9 (3.3) 0.739
Open distal anastomosis 99 (68) 71 (55) 170 (62) 0.024
Distal aortic anastomosis 28 (19) 17 (13) 45 (16) 0.171
Between IA and LCCA 7 (4.8) 1 (0.8) 8 (2.9) 0.070
Between LCCA and LSA 12 (8.3) 12 (9.3) 24 (8.8) 0.764
Total arch 9 (6.2) 4 (3.1) 13 (4.7) 0.227
Cardiopulmonary bypass details
ECC time, min 238 ± 72 222 ± 70 231 ± 71 0.063
Cross-clamp time, min 134 ± 49 130 ± 49 132 ± 49 0.530
DHCA 138 (95) 121 (94) 259 (95) 0.618
Duration, min 38 ± 19 36 ± 22 37 ± 20 0.309
ASCP 106 (73) 81 (63) 187 (68) 0.067
Unilateral 10 (6.9) 14 (11) 24 (8.8) 0.248
Bilateral 96 (66) 67 (52) 163 (59) 0.016
Duration, min 39 ± 42 34 ± 38 37 ± 40 0.294
Lowest core body temperature 22.6 ± 2.7 22.6 ± 3.5 22.6 ± 3.0 0.922
> 25 °C 9 (6.2) 4 (3.1) 13 (4.7) 0.768
20-25 °C 54 (37) 30 (23) 84 (31) 0.947
< 20 °C 12 (8.3) 8 (6.2) 20 (7.3) 0.674
Not reported 70 (48) 87 (67) 157 (57) 0.001

Values are mean ± SD or n (%). ASCP percentages are related to DHCA. SCAR: Supracoronary aortic replacement; IA: innominate artery; LCCA:
left common carotid artery; LSA: left subclavian artery; ECC: extracorporeal circulation; DHCA: deep hypothermic circulatory arrest; ASCP:
antegrade selective cerebral perfusion. Significant differences (P value < 0.05) are underlined.

performed more in the DA cannulation group (39.5% vs. 27.6%, P = 0.036) and SCAR with open distal
anastomosis but without arch were performed more often in the FA cannulation group (68.3% vs. 55.0%,
P = 0.024). All patients, except one, undergoing SCAR with cross-clamp, equally distributed between direct
aortic and femoral cannulation (4% vs. 3%, P = 0.739), had DeBakey type II aortic dissection. Most patients
received ASCP apart from 39 cases (18 DA and 21 FA). However, data regarding the use of ASCP, either
unilateral or bilateral, were missing from 48 patient records (30 DA and 18 FA). All procedural details
including bypass times and other operative variables are shown in Table 1.

There were no statistically significant differences regarding surgical mortality (DA 7.8% vs. FA 11.7%,
P = 0.271) nor new permanent neurological damage (respectively 10.9% and 6.9%, P = 0.248) between both
groups. Patients in the DA group required, although non-significant, more pericardiocentesis, subxiphoid
pericardiotomy, and resternotomy for bleeding more than 48 h after primary intervention (22.5% vs. 13.8%,
P = 0.061). Additionally, there were no significant differences in the number of patients with AKI and those