Direct aortic cannulation versus femoral arterial cannulation for early outcomes in acute type A aortic dissection: A study-level meta-analysis

Author:

Yamashita Yoshiyuki1ORCID,Sicouri Serge1,Kjelstrom Stephanie2,Montone Georgia2,Dokollari Aleksander3,Ridwan Khalid4,Clarke Nicholas4,Rodriguez Roberto4,Goldman Scott M.4,Ramlawi Basel14

Affiliation:

1. Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA

2. Main Line Health Center for Population Health Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA

3. Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada

4. Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA

Abstract

Purpose To investigate the impact of direct aortic cannulation (DAC) versus femoral arterial cannulation (FAC) on clinical outcomes of surgery for acute type A aortic dissection. Methods PubMed/MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were searched until August 25, 2023, to conduct a meta-analysis. Primary endpoints of the study were operative mortality and postoperative stroke. Secondary endpoints were cardiopulmonary bypass time, myocardial ischemic time, hypothermic circulatory arrest time, temporary neurological dysfunction (TND), combined stroke and TND, re-exploration for bleeding, and need for renal replacement therapy. A random-effect model was used to estimate the pooled effect size, and a leave-one-out method was used for the primary endpoints for sensitivity analysis. Results 15 studies met our eligibility criteria, including a total of 7941 samples. Operative mortality was significantly lower in the DAC group with a pooled odds ratio (OR) of 0.72 [95% confidence interval (CI): 0.61–0.85)]. Incidence of postoperative stroke was also lower in the DAC group with a pooled OR of 0.79 (95% CI: 0.66–0.94). However, after excluding one study with the greatest weight, the difference became nonsignificant. DAC was also associated with a lower incidence of postoperative TND, and re-exploration for bleeding with a pooled OR of 0.52 (95% CI: 0.37–0.73), and 0.60 (95% CI: 0.47–0.77), respectively. Conclusions This meta-analysis showed that patients who underwent ATAAD repair with DAC had a lower incidence of operative mortality, postoperative stroke, TND, and re-exploration for bleeding compared to those who underwent FAC.

Funder

the Sharpe-Strumia foundation of Bryn Mawr Hospital

Publisher

SAGE Publications

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