Cannulation Strategies in Acute Type A Aortic Dissection: Is Femoral Cannulation Truly Detrimental?

Background: The optimal cannulation strategy for acute type A aortic dissection (ATAAD) remains controversial. Femoral artery, axillary artery, ascending aorta, or apical cannulation is used depending on the clinical scenario; however, no consensus on use has currently been established. Thus, this study aimed to compare the outcomes of femoral artery and central aortic cannulation. Methods: This study retrospectively analyzed 92 patients who underwent emergency surgery for ATAAD between April 2023 and March 2025. Femoral artery cannulation was performed in 71 patients (77%), ascending aortic cannulation in 11 (12%), brachiocephalic in 6 (7%), and apical in 4 (4.3%). Results: Baseline characteristics did not differ significantly between the femoral and central aortic groups. Total arch replacement was performed more frequently in the femoral group (32%) than in the central aortic cannulation group (0%; p = 0.029). Postoperative stroke occurred in 2.8% of the individuals in the femoral group and 0% of the central aortic cannulation group. Similarly, 30-day mortality did not differ between the groups. The multivariate analysis did not identify any significant predictors of postoperative stroke. However, prolonged operative time was associated with 30-day mortality (odds ratio, 1.01; p = 0.00467). The time from skin incision to cardiopulmonary bypass initiation did not significantly affect patient outcomes. Conclusion: Excluding cases at high risk of embolization due to retrograde perfusion, both ascending aortic and femoral cannulations can be safely utilized as arterial inflow sites. Therefore, tailoring the cannulation strategy to each patient is essential.