A comparative study of axillary and innominate artery cannulation: insights from clinical experience in acute type A aortic dissection

Introduction
Stanford acute type A aortic dissection (ATAAD) repair requires complex circulatory and cerebral protection. Although various neuroprotective techniques have been proposed, the optimal strategy remains controversial.

Aim
This study compared innominate artery (IA) and right axillary artery (AXA) cannulation in ATAAD repair based on early- and mid-term outcomes.

Material and methods
Forty-six patients who underwent emergency ATAAD repair between January 2021 and April 2024 were retrospectively analyzed. Group 1 included patients with AXA cannulation (n = 18), and group 2 consisted of IA cannulation cases (n = 28). Primary endpoints were operative mortality (all-cause mortality at 30 days), postoperative neurological events, and major adverse cardiac and cerebrovascular events (MACCEs). Secondary endpoints included re-exploration, stroke, upper limb ischemia, and wound infections.

Results
No statistically significant differences were found between the groups regarding early mortality and cerebral events. Thirty-day mortality was 33.3% (n = 6) in the AXA group and 21.4% (n = 6) in the IA group (p = 0.493). Stroke or TIA occurred in 11.1% (n = 2) of AXA patients and 7.1% (n = 2) of IA patients (p = 0.549). Intensive care unit and hospital stays, end-organ complications, and re-exploration rates were similar. Kaplan-Meier survival analysis showed comparable 1-year survival (66.7% vs. 82.8%, p = 0.558). Logistic regression identified coronary artery disease (OR = 4.364), aortic diameter (OR = 1.219), lowest body temperature (OR = 0.788), and AXA cannulation (OR = 0.115) as independent predictors of mortality.

Conclusions
Both IA and AXA cannulation are effective for ATAAD repair. However, IA cannulation reduced cannulation-related complications, offering a safe alternative for antegrade cerebral perfusion with comparable early mortality and complication rates.