Comparison Between the Impact of Antegrade Versus Retrograde Arterial Cannulation Techniques on the Early Outcome of Patients with Type A Aortic Dissection

Ahmed Ahmed; Ashraf Elsebaie; Tamer Siam; Hosam Abdel Hamid; Mohamed Essa

Ahmed Ahmed Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt http://orcid.org/0000-0003-4748-6282
Ashraf Elsebaie Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Tamer Siam Department of Cardiothoracic Surgery, Faculty of Medicine, Misr University for Science and Technology, Cairo, Egypt
Hosam Abdel Hamid Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Mohamed Essa Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Keywords: Aortic dissection, Arterial cannulation, Antegrade Cannulation, Retrograde cannulation

Abstract

Background: Acute type A aortic dissection represents one of the most critical emergencies in cardiovascular surgery, demanding rapid diagnosis and prompt operative intervention. Despite significant advances in surgical strategies and perioperative management, morbidity and mortality remain high, and the choice of cannulation technique continues to generate debate among surgeons worldwide.

Methods: It is a prospective non randomized comparative study aimed to compare the early outcome of repair of type A aortic dissection using different cannulation techniques by sorting them into two groups, Group 1, The antegrade group (30 patients) in which axillary, innominate and central cannulation was done and Group 2, the retrograde group (30 patients) in which femoral cannulation was done from March 2021 till September 2025.

Results: The mean age was 56.2 ± 11.4 for group 1 and 58.6 ± 10.7 for group 2. The in-hospital mortality was 2 patients (6.7%) in the antegrade group versus 5 patients (16.7%) in the retrograde group while the 30-day mortality was 3 patients (10%) in the antegrade group versus 6 patients (20%) in the retrograde group.

Conclusion: Antegrade and retrograde cannulation both remain safe and effective strategies in managing acute type A aortic dissection. Antegrade approaches showed meaningful advantages in procedural efficiency, cerebral protection, and recovery outcomes. When pathology and surgical expertise permit, antegrade cannulation should be favored. while retrograde access remains a reliable option in emergency cases.