Objective:

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).

Approach:

• Study Design: A single-center, retrospective cohort study involving 94 consecutive ATAAD patients who underwent surgery between May 2024 and May 2025.
• Group Allocation: Patients were divided into two groups: IA group (n = 56) and IA + FA group (n = 38) based on the perfusion strategy.
• Endpoints: Primary endpoint was 30-day all-cause mortality; secondary endpoints included total operative duration, aortic cross-clamp time, and major postoperative complications.

Key Findings:

• Total operative time was significantly shorter in the IA group (370.05 ± 63.34 min) compared to the IA + FA group (397.26 ± 62.11 min, p = 0.04).
• No significant differences in 30-day mortality (10.71% vs. 21.05%, p = 0.28) or major complications between groups.
• Numerical trends favored the IA group for rates of re-sternotomy and new requirement for hemodialysis.

Interpretation:

Isolated innominate artery antegrade perfusion reduces operative time compared to combined IA + FA without compromising early safety outcomes.

Limitations:

• Retrospective design may introduce selection bias.
• Single-center study limits generalizability.

Conclusion:

The study suggests that IA may be a more efficient first-line perfusion strategy for ATAAD surgery, with IA + FA potentially reserved for specific cases.