Clinical Practice Variation and Outcomes for Stanford Type A Aortic Dissection Repair Surgery in Maryland: Report from a Statewide Quality Initiative

Central versus peripheral cannulation for acute type A aortic dissection: A meta-analysis of over 14,000 patients

OBJECTIVE

The optimal cannulation strategy for patients with acute type A aortic dissections (ATAAD) is unclear.

METHODS

A systematic search was performed to identify all studies comparing aortic and non-aortic cannulation in patients undergoing ATAAD repair. The primary endpoint was overall survival. The secondary endpoints were operative mortality, postoperative stroke, renal failure, renal replacement therapy, paraplegia, and mesenteric ischemia. Pooled meta-analyses with aggregated and reconstructed time-to-event data were performed.

RESULTS

Twenty-three studies were included (aortic: 3904; non-aortic: 10,719). Ten-year overall survival was 61.1 ​% and 58.4 ​% for aortic and non-aortic cannulation, respectively (HR 1.07; 95 ​% CI 0.92-1.25; p ​= ​0.38). No statistically significant difference was observed for operative mortality (p ​= ​0.10), stroke (p ​= ​0.89), renal failure (p ​= ​0.83), or renal replacement therapy (p ​= ​0.77).

CONCLUSION

Patients undergoing surgery for ATAAD can undergo aortic cannulation with similar outcomes to those who undergo non-aortic cannulation.