Innominate artery versus combined innominate and femoral artery perfusion in acute type A aortic dissection: a comparison of surgical efficiency and early outcomes.

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.