Single Arterial Cannulation vs. Dual Arterial Cannulation during Acute Type A Aortic Dissection Repair: A Systematic Review and Meta-Analysis.

OBJECTIVE

Acute type A aortic dissection (ATAAD) is a cardiovascular emergency with high mortality and morbidity. We compared the effects on outcomes of single arterial cannulation (SAC) via axillary, femoral, or ascending aorta with double arterial cannulation (DAC) via axillary and femoral artery during ATAAD repair.

METHODS

We conducted a systematic review and meta-analysis of observational studies from PubMed, Web of Science, Scopus, EMBASE, and Cochrane searches through April 30, 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using R version 4.3. The protocol is registered on PROSPERO (CRD42024535644).

RESULTS

Our analysis included 7 studies encompassing 3,534 patients. DAC was associated with a significantly longer intensive care unit stay than SAC (MD 0.45 days, 95% CI 0.10, 0.79, p = 0.01). However, there was no significant difference between DAC and SAC in the length of hospital stay (MD 1.39 days, 95% CI -2.70, 5.47, p = 0.51). Also, there was no significant difference between the two approaches in the incidence of stroke (RR 1.12, 95% CI 0.77, 1.64, p = 0.55), paraplegia (RR 0.59, 95% CI 0.32, 1.07, p = 0.08), or acute kidney injury (RR 0.83, 95% CI 0.55, 1.24, p = 1.24).

CONCLUSION

Our meta-analysis shows that during ATAAD repair, DAC was associated with slightly longer intensive care stay, which was of doubtful clinical significance. However, both approaches were comparable for hospital stay, the incidence of stroke, paraplegia, or acute kidney injury.

IMPLICATIONS FOR CLINICAL PRACTICE

Despite comparable overall outcomes, we observed that DAC was associated with higher risks of requiring continuous renal replacement therapy or dialysis, and reintubation. This emphasizes the need to carefully consider cannulation strategies based on patient factors to balance potential benefits and risks.