140. Aortic versus Axillary Cannulation for Aortic Arch Surgery

Objective: Central aortic cannulation for aortic arch surgery has become more popular among aortic surgeons over the last decade, however, evidence comparing it to axillary artery cannulation remains equivocal. This study compares postoperative outcomes of patients who underwent axillary artery and central aortic cannulation for cardiopulmonary bypass during aortic arch surgery.
Methods: A retrospective review of all patients who underwent aortic arch surgery at our institution between 2005 and 2020 was performed. Patients who underwent previous aortic surgery and patients who were cannulated at a site other than the axillary artery or aorta were excluded. The primary outcome of interest was failure to achieve uneventful recovery, defined as having experienced at least one of the following complications: in-hospital mortality, stroke, bleeding requiring re-operation, prolonged ventilation, renal failure, mediastinitis, superficial surgical site infection, and pacemaker or ICD implantation. Nearest neighbor propensity score matching was used to account for baseline differences across the groups. Outcomes were compared using the Chi-Squared Test.
Results: Among the 724 patients (axillary: 457 vs. aorta: 267) who met inclusion and exclusion criteria, 420 patients (axillary: 210 vs. aorta: 210) remained after propensity score matching. Within the matched cohort, 32.4% of patients (133/410) underwent urgent or emergent surgery; aneurysm was the most common surgical indication at 69.3% of patients (284/410) followed by dissection at 26.6% of patients (109/410); the aortic root was replaced in 52.9% of patients (217/410); and the extent of aortic replacement was defined as hemi-arch in 59.0% of patients (242/410). Propensity score matching resulted in comparable groups. There was no significant difference in the composite outcome of failure to achieve uneventful recovery across groups in the unmatched (axillary: 33.3% [152/457] vs. aorta: 32.3% [86/267]; p = 0.269) or matched (axillary: 31.9% [67/210] vs. aorta: 31.9% [67/210]; p = 0.492) cohorts. There was also no significant difference in each of the individual outcomes included in failure to achieve uneventful recovery across groups in both the unmatched and matched cohorts. Stroke occurred in 16 patients in the axillary group and in 12 patients in the aorta group (p = 0.557). Twelve patients died in-hospital in the axillary group whereas 8 patients died in-hospital in the aorta group (p = 0.492). The most common postoperative complication in both cohorts was prolonged ventilation, which in the matched cohort occurred in 33 patients in the axillary group and 38 patients in the aorta group (p = 0.603).
Conclusions: Central aortic cannulation does not appear to be inferior to axillary arterial cannulation in aortic arch surgery.

Kerry Filtz (1), Michael Simpson (1), Samantha Nemeth (1), Yaagnik Kosuri (1), Paul Kurlansky (1), Virendra Patel (1), Hiroo Takayama (1), (1) New York Presbyterian/Columbia, New York, NY

Anthony Estrera

Invited Discussant

Dr. Estrera is Professor and Chair of the Department of Cardiothoracic and Vascular Surgery at UT Health Houston  McGovern Medical School  and Co-Director of the Memorial Hermann Heart and Vascular Institute System service line. He has been an integral part in building the department and the cardiovascular surgical service at McGovern Medical School. His specialty is in diseases of the aorta with a focus on thoracoabdominal aortic aneurysms and aortic dissection. Dr. Estrera has co-edited one textbook on Aortic Diseases and Management and has authored or co-authored 35 book chapters and more than 300 articles in peer-reviewed medical journals. His studies led to refinements in surgical techniques for the treatment of thoracic aortic aneurysms and aortic dissection. He also collaborated with UTHealth faculty to identify multiple genes associated with the etiology of thoracic aortic aneurysm and aortic dissection. Dr. Estrera has lectured and conducted workshops worldwide and has provided critical training for current and future cardiovascular surgeons. Dr. Estrera is a fellow of The American College of Surgeons, American Heart Association,  and a member of the American Association for Thoracic Surgeons, the Society of Thoracic Surgeons, Society of Vascular Surgeons,  DeBakey International Surgical Society, Southern Thoracic Surgical Association, and Alpha Omega Alpha Honor Society. Dr. Estrera is certified with both the American Board of Surgery and the American Board of Thoracic Surgery, and he serves on the editorial board for the Annals of Thoracic Surgery and the Journal Aorta. He is member of the Board of directors of the Society of Thoracic Surgeons, Thoracic Surgery Foundation (treasurer(=) and the Houston Aortic Symposium. He is the past President of the Texas Surgical Society.

Kerry Filtz

Abstract Presenter

Kerry is a fourth year medical student at Columbia University Vagelos College of Physicians and Surgeons planning to go into general surgery.

Specialties: Adult Cardiac, Aorta, Mechanical Circulatory Support, Perioperative Management/Critical Care, Anatomy and Conditions, Great Vessels, Aorta, Aortic root, Aortic Arch, General Thoracic, Thoracic, Mechanical Circulatory Support, Perioperative Management/Critical Care, Treatment/Procedure/Operation/Surgery, Lung, Mechanical Circulatory Support/Lung