Premium
Femoral versus axillary cannulation in acute type A aortic dissections: A meta‐analysis
Author(s) -
Hussain Azhar,
Uzzaman Mohsin,
Mohamed Sameh,
Khan Fakyha,
Butt Salman,
Khan Habib
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15810
Subject(s) - medicine , odds ratio , surgery , stroke (engine) , meta analysis , confidence interval , aortic dissection , axillary artery , randomized controlled trial , incidence (geometry) , cardiopulmonary bypass , anesthesia , aorta , mechanical engineering , physics , optics , engineering
Objective There has been a growing interest in antegrade cannulation techniques in type A aortic dissection surgery. Axillary cannulation has previously been reported to provide better outcomes in terms of short‐term mortality and neurological event. Consensus regarding the best cannulation strategy still remains controversial. Method The MEDLINE and EMBASE databases were conducted up until October 3, 2020. Data regarding mortality, stroke, reoperation for bleeding and length of hospital stay, wound infection and cardiopulmonary bypass time were extracted and submitted to a meta‐analysis using random‐effects modelling and the I 2 ‐test for heterogeneity. Fourteen retrospective observational studies were included, enrolling a total of 2621 patients. Results There were a total of 2621 patients (1327 axillary cannulation and 874 femoral cannulation). Axillary cannulation was associated with reduced short term mortality (pooled odds ratio [OR] = +0.42, 95% confidence interval [CI] = +0.25 to +0.70; p = .0009) compared to femoral cannulation. Axillary cannulation was also associated with a lower incidence of neurological events (pooled OR = +0.63, 95% CI = +0.42 to +0.94; p = .02). Conclusion Our meta‐analyses suggests that axillary cannulation has superior outcomes in terms of mortality and stroke following emergency surgery for type A aortic dissection. However, the lack of high quality randomized controlled trials does not make this recommendation generalisable to all units.