Cannulation Strategy:
The most common approaches to establish arterial inflow have utilized
the femoral artery, the subclavian/axillary artery, and/or more recently
the ascending aorta or proximal aortic arch.15E ach strategy offers different advantages and inherent risks for
complications, and the optimal cannulation for CPB is still debated16. A recent meta-analysis 17 found
better short term outcomes with antegrade perfusion via axillary artery
while another meta-analysis from Benedetto and colleagues18 found reduced in-hospital mortality and incidence
of permanent stroke with antegrade perfusion via central cannulation
(including both axillary and direct aortic cannulation) when compared to
femoral artery retrograde flow. Etz and colleagues found better long
term survival with antegrade perfusion (included both axillary artery
and direct ascending aorta cannulation) 19. Other
studies have found no difference 2021-23. Patient’s hemodynamic stability, extent of
dissection, level of the planned distal repair and surgeon’s preference
are some of the variables that determine the choice20.