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Subclavian Cannulation Improves Outcome of Surgery for Type A Aortic Dissection

Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne
¹ Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom

For reprint information contact: Seyed M Nouraei, FRCS Tel: 44 191 284 7081 Fax: 44 870 458 0775 Email: SMNouraei{at}yahoo.co.uk, 6 Finstock Court, Newcastle upon Tyne, NE3 1TR, United Kingdom.

Acute type A aortic dissection is a major emergency that continues to cause significant morbidity and mortality. Given the anatomy of the lesion, different circulatory configurations achieved during cardiopulmonary bypass using different arterial inflow sites can influence outcome. Patients who had subclavian artery cannulation were compared with those who had femoral artery cannulation. Forty-nine consecutive patients (mean age, 60 ± 14 years) undergoing emergency surgery for acute type A aortic dissection between 1999 and 2004 were reviewed. Data on presentation, preoperative characteristics, operative details, hospital mortality, and neurological outcome were analyzed. Twenty-nine patients had femoral artery cannulation, and 20 had subclavian artery cannulation. The groups were comparable in terms of preoperative characteristics. The mean follow-up was 29 months. Subclavian artery cannulation conferred significant advantages in respect of hospital death (10% vs. 44%) and neurological impairment. Significantly fewer patients required re-operation following subclavian artery cannulation.

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