• Stefan Klotz, Kathrin Heuermann, Thorsten Hanke, Michael Petersen, and Hans-Hinrich Sievers.
• Department of Cardiac and Thoracic Vascular Surgery, University Hospital Luebeck, Luebeck, Germany stefan.klotz@uksh.de.
• Interact Cardiovasc Thorac Surg. 2015 Jun 1; 20 (6): 749-53; discussion 754.

ObjectivesAcute aortic dissection type A (AADA) is still an emergency operation with high morbidity and mortality. In this acute situation quick cannulation to the heart-lung machine and systemic cooling is often life-saving. However, the often easy access to the femoral vessels for cannulation leads to an arterial backflow in the descending aorta with the likelihood of plaque rupture and cerebral embolism. We analysed the outcome after initial femoral versus central cannulation for AADA.MethodsAll patients with acute aortic dissection type A operated between January 2003 and December 2012 were evaluated for the type of arterial cannulation (femoral vs central) for initial bypass. Demographic data and outcome parameters were accessed. No patient was excluded.ResultsOne hundred and seventy-seven patients were operated on with acute type A dissection in the last 10 years; 94 (53.1%) were initially cannulated in the central aortic vessels and 83 (46.9%) in the femoral artery. The patients were comparable with regard to age (61.1 ± 14.9 vs 62.2 ± 15.0 years, P = 0.607), gender (male, 62 vs 69%, P = 0.348), EuroSCORE (11.5 ± 4.0 vs 12.8 ± 4.3, P = 0.057) and previous sternotomy (17% in both groups). Bypass (243 ± 105 vs 233 ± 83 min, P = 0.471), cross-clamp (160 ± 86 vs 150 ± 66 min, P = 0.381) and circulatory arrest times (47.8 ± 24.7 vs 42.5 ± 21.7 min, P = 0.130) were similar as were lowest temperatures (17.7 ± 1.8 vs 17.6 ± 1.3, P = 0.652). Postoperative cerebral infarction and 30-day mortality were comparable between the cannulation groups (13 vs 9%, P = 0.449 and 20 vs 17%, P = 0.699, central vs peripheral cannulation). Only postoperative need for dialysis was borderline significantly higher in the femoral cannulation group (28 vs 40%, P = 0.073).ConclusionsThis single-centre study with 177 patients could show that an acute aortic dissection type A can be operated on with central and peripheral cannulation with similar results. Risk for early mortality was driven by the preoperative clinical and haemodynamic status before operation rather than the cannulation technique.© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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