(P193) OUTCOMES OF AXILLARY VS FEMORAL ARTERIAL CANNULATION IN ACUTE TYPE A DISSECTION REPAIR: AN INTERNATIONAL MULTICENTRE STUDY

Background: Single center studies suggest axillary arterial cannulation is safe to perform in Acute Type A Dissection (ATAD) and may be associated with reduced stroke risk. Cannulation strategies in ATAD are variable with no consensus as to the safest and most effective technique. We therefore sought to compare perioperative outcomes of Axillary versus Femoral arterial cannulation in a large cohort of ATAD among the global IRAD Investigators.

METHODS AND RESULTS: Patients undergoing Acute type A dissection repair with axillary or femoral arterial cannulation between 1997 and 2021 were investigated from the IRAD Registry. After exclusion of patients undergoing direct aortic or innominate cannulation and those presenting with type B dissection, 2270 patients remained (Axillary 1155, 51%; Femoral 1115, 49%). Multivariable logistic regression was performed to account for baseline and intraoperative differences. Propensity Score matching was performed as a sensitivity analysis (results reported for the overall cohort). Age, hypertension, bicuspid aortic valve, Marfan syndrome, and mixed aortic valve disease were similar between groups, while Femoral patients had greater incidence of aortic insufficiency (N=434, 55%; N=480, 61%; p=0.04), renal malperfusion (N=60, 6%; N=84, 8%; p=0.031), and coma (N=93, 8%; N=123, 12%; p=0.02). Arch and root replacement interventions were more commonly performed among Axillary patients (Axillary: n=305 31%; Femoral: n=204 25% p=0.01) as was use of cerebral perfusion (Axillary: n=968, 87%; Femoral: n=731, 69% p<.0001). Unadjusted comparison demonstrated no significant difference in risk of perioperative death (Axillary: n=174, 15%; n=161, 14%, p=0.72), stroke (Axillary: n=96, 10%; Femoral: n=107, 11%, p=0.37), or any perioperative outcome of interest (Table 1). Perioperative outcomes remained similar after multivariable logistic regression. Independent predictors of death in multivariate analysis included shock [OR 2.030, 95%CI(1.074, 3.839), p= 0.0294], malperfusion [Coronary: OR 1.74 95%CI (1.12, 2.71), p=0.0135; Limb: OR 2.65 95%CI(1.65, 4.27), p<.0001), and absence of cerebral perfusion [OR 3.21, 95%CI(1.553 6.620), p=0.0016] (Figure 1). Extended arch intervention and history of stroke [OR4.40, 95%CI(1.16,16.67), p=0.029] were also independently associated with perioperative stroke risk (Figure 1).

Conclusion: International multicentre data over two decades suggest that axillary and femoral cannulation strategies are associated with equivalent early mortality, stroke, tamponade, and malperfusion outcomes in ATAD, after statistical adjustment. Axillary cannulation is associated with more extensive aortic reconstruction. Further study required to assess differences in cognitive neurological outcomes by cannulation strategy.