Abstract
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.