Frontiers in cardiovascular medicine · 2026
Innominate artery versus combined innominate and femoral artery perfusion in acute type A aortic dissection: a comparison of surgical efficiency and early outcomes.
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Wu Lina, Liu Li, Wei Jun, Zhang Yang, Chen Fangyuan, Lu Yun
Аннотация
OBJECTIVE: This study aimed to compare the impact of isolated innominate artery antegrade perfusion (IA) versus combined innominate and femoral artery perfusion (IA + FA) on surgical efficiency and short-term outcomes in patients undergoing surgery for acute type A aortic dissection (ATAAD).
METHODS: A single-center, retrospective cohort study was conducted involving 94 consecutive ATAAD patients who underwent surgery between May 2024 and May 2025. Patients were allocated into two groups based on the perfusion strategy: the IA group (n = 56) and the IA + FA group (n = 38). The primary endpoint was 30-day all-cause mortality. Secondary endpoints included total operative duration, aortic cross-clamp time, and the incidence of major postoperative complications (e.g., cerebral infarction, acute kidney injury, re-sternotomy). Statistical analyses were performed to compare intergroup differences.
RESULTS: The two groups were well-balanced in terms of baseline demographics and preoperative risk profiles. The total operative time was significantly shorter in the IA group compared to the IA + FA group (370.05 ± 63.34 min vs. 397.26 ± 62.11 min, p = 0.04), while no significant differences were observed in aortic cross-clamp time or deep hypothermic circulatory arrest duration. Regarding safety outcomes, there were no statistically significant differences in 30-day mortality (10.71% vs. 21.05%, p = 0.28), postoperative cerebral infarction (14.29% vs. 15.79%, p = 1.00), or acute kidney injury (21.43% vs. 26.32%, p = 0.76). However, numerical trends favoring the IA group were observed for rates of re-sternotomy and new requirement for hemodialysis.
CONCLUSION: For ATAAD surgery, an isolated innominate artery antegrade perfusion strategy significantly improves surgical efficiency by reducing operative time without compromising early safety outcomes, compared to a combined IA + FA approach. The routine addition of femoral artery perfusion did not confer measurable clinical benefits in this cohort. Thus, IA should be considered as a streamlined and efficient first-line perfusion strategy, potentially reserving IA + FA for select cases with specific indications. These findings warrant further validation in larger, prospective studies.
METHODS: A single-center, retrospective cohort study was conducted involving 94 consecutive ATAAD patients who underwent surgery between May 2024 and May 2025. Patients were allocated into two groups based on the perfusion strategy: the IA group (n = 56) and the IA + FA group (n = 38). The primary endpoint was 30-day all-cause mortality. Secondary endpoints included total operative duration, aortic cross-clamp time, and the incidence of major postoperative complications (e.g., cerebral infarction, acute kidney injury, re-sternotomy). Statistical analyses were performed to compare intergroup differences.
RESULTS: The two groups were well-balanced in terms of baseline demographics and preoperative risk profiles. The total operative time was significantly shorter in the IA group compared to the IA + FA group (370.05 ± 63.34 min vs. 397.26 ± 62.11 min, p = 0.04), while no significant differences were observed in aortic cross-clamp time or deep hypothermic circulatory arrest duration. Regarding safety outcomes, there were no statistically significant differences in 30-day mortality (10.71% vs. 21.05%, p = 0.28), postoperative cerebral infarction (14.29% vs. 15.79%, p = 1.00), or acute kidney injury (21.43% vs. 26.32%, p = 0.76). However, numerical trends favoring the IA group were observed for rates of re-sternotomy and new requirement for hemodialysis.
CONCLUSION: For ATAAD surgery, an isolated innominate artery antegrade perfusion strategy significantly improves surgical efficiency by reducing operative time without compromising early safety outcomes, compared to a combined IA + FA approach. The routine addition of femoral artery perfusion did not confer measurable clinical benefits in this cohort. Thus, IA should be considered as a streamlined and efficient first-line perfusion strategy, potentially reserving IA + FA for select cases with specific indications. These findings warrant further validation in larger, prospective studies.