Central aortic versus axillary artery cannulation for aortic arch surgeryCentral MessagePerspective
Megan M. Chung, BA,
Kerry Filtz, MD,
Michael Simpson, MD,
Samantha Nemeth, MS, MA, MPH,
Yaagnik Kosuri, MD,
Paul Kurlansky, MD,
Virendra Patel, MD, MPH,
Hiroo Takayama, MD, PhD
Affiliations
Megan M. Chung, BA
Division of Cardiothoracic and Vascular Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
Kerry Filtz, MD
Columbia University Vagelos College of Physicians and Surgeons, New York, NY
Michael Simpson, MD
Division of Cardiothoracic and Vascular Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
Samantha Nemeth, MS, MA, MPH
Center for Innovation and Outcomes Research, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
Yaagnik Kosuri, MD
Division of Cardiothoracic and Vascular Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
Paul Kurlansky, MD
Center for Innovation and Outcomes Research, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
Virendra Patel, MD, MPH
Division of Cardiothoracic and Vascular Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
Hiroo Takayama, MD, PhD
Division of Cardiothoracic and Vascular Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY; Address for reprints: Hiroo Takayama, MD, PhD, Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, 177 Fort Washington Ave, New York, NY 10019.
Objective: Central aortic cannulation for aortic arch surgery has become more popular over the last decade; however, evidence comparing it with axillary artery cannulation remains equivocal. This study compares outcomes of patients who underwent axillary artery and central aortic cannulation for cardiopulmonary bypass during arch surgery. Methods: A retrospective review of 764 patients who underwent aortic arch surgery at our institution between 2005 and 2020 was performed. The primary outcome was failure to achieve uneventful recovery, defined as having experienced at least 1 of the following: in-hospital mortality, stroke, transient ischemic attack, bleeding requiring reoperation, prolonged ventilation, renal failure, mediastinitis, surgical site infection, and pacemaker or implantable cardiac defibrillator implantation. Propensity score matching was used to account for baseline differences across groups. A subgroup analysis of patients undergoing surgery for aneurysmal disease was performed. Results: Before matching, the aorta group had more urgent or emergency operations (P = .039), fewer root replacements (P < .001), and more aortic valve replacements (P < .001). After successful matching, there was no difference between the axillary and aorta groups in failure to achieve uneventful recovery, 33% versus 35% (P = .766), in-hospital mortality, 5.3% versus 5.3% (P = 1), or stroke, 8.3% versus 5.3% (P = .264). There were more surgical site infections in the axillary group, 4.8% versus 0.4% (P = .008). Similar results were seen in the aneurysm cohort with no differences in postoperative outcomes between groups. Conclusions: Aortic cannulation has a safety profile similar to that of axillary arterial cannulation in aortic arch surgery.
