Cannulation Is Safe and Effective to Establish Cardiopulmonary Bypass in Aortic Dissection Repair

aortic dissection
Although there has been a recent shift away from femoral cannulation, these study results demonstrated that it is a safe and effective procedure for aortic dissection repair and provides excellent outcomes for establishing cardiopulmonary bypass.

Femoral arterial cannulation is safe and provides excellent results for establishing cardiopulmonary bypass in patients undergoing surgical repair for type A aortic dissection, researchers reported in the Journal of Thoracic Disease.

Axillary artery and direct ascending aortic cannulation have been used increasingly during the past 2 decades in place of femoral cannulation owing to concerns for malperfusion syndrome and the risk for embolization to the brain.

The retrospective study included 52 consecutive patients (mean age, 66±12 years; 65% male; 53% White) who had surgical repair for type A aortic dissection at a single center from January 1, 2012 to June 30, 2019. From the cohort, 35 (67.3%) patients had femoral artery cannulation, 11 (21.2%) had direct ascending aortic cannulation, and 6 (11%) had axillary artery cannulation for arterial access. All patients had central cannulation of the right atrium for venous access, as well as deep hypothermic circulatory arrest and unilateral antegrade cerebral perfusion.

In all patients with femoral arterial cannulation, cardiopulmonary bypass was established. No complications were observed specifically relating to the 3 cannulation approaches.

The bleeding rate for patients with femoral cannulation (13%) was higher compared with the rate for the other cannulation approaches (6%), although the bleeding was not related to the cannulation site. Among all patients who underwent repair for type A dissection, the mortality rate was 27% (14/52) and the bleeding rate was 19% (10/52).

The retrospective study may have potential inherent limitations such as bias; however, a cardiothoracic surgeon and an independent non-cardiothoracic surgeon analyzed all data to confirm its accuracy. In addition, the investigators noted they would prefer a sample size of >100 patients for this type of analysis.

“Femoral arterial cannulation remains a safe and reliable option that all cardiothoracic surgeons should be able to perform,” the researchers concluded.


Lemaire A, Chao J, Salgueiro L, et al. Femoral arterial cannulation remains a safe and reliable option for aortic dissection repair. J Thorac Dis. 2021;13(2):1005-1010. doi:10.21037/jtd-20-2549