ArticleInterdisciplinary cardiovascular and thoracic surgery2025
Short- and mid-term outcomes of surgical repair of acute type A aortic dissection and concomitant coronary artery bypass grafting or extracorporeal membrane oxygenation support.
Article in Interdisciplinary cardiovascular and thoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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9 authors.
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Abstract
objectivesIn this study, we aimed to retrospectively analyse the risk factors for failing to wean from CPB and short- and mid-term outcomes of surgical repair of acute type A aortic dissection (TAAD) and concomitant coronary artery bypass grafting (CABG) versus extracorporeal membrane oxygenation (ECMO) support in patients.
methodsTwo hundred and three patients were enrolled and categorized into the simple TAAD group (n = 106) or the complex TAAD group (n = 97). Following propensity score matching, 68 patients in the complex TAAD group were distributed between the CABG subgroup (n = 34) and the ECMO subgroup (n = 34) for further analysis. Five-year survival was analysed using the Kaplan-Meier method. Multivariable logistic regression analysis was used to identify independent risk factors for failing to wean from cardiopulmonary bypass (CPB).
resultsThe complex TAAD group had higher in-hospital mortality than the simple TAAD group (29.9% vs 16.9%, P = 0.049). Multivariable analysis revealed that preoperative high-value cardiac troponin I, operation time, CPB time and circulation assisted time were risk factors for failing to wean from CPB (P = 0.050, 95% CI 1.000-1.105; P = 0.046, 95% CI 1.011-3.143; P = 0.044, 95% CI 1.001-1.039; P < 0.01, 95% CI 1.025-1.092, respectively). There was no significant difference in in-hospital mortality between the CABG and ECMO subgroups (5.9% vs 20.6%, P = 0.15). In contrast, the CABG subgroup demonstrated significantly improved 5-year overall survival compared with the ECMO subgroup, with a statistically significant difference (log-rank P = 0.04).
conclusionsPreoperative high-value cardiac troponin I, operation time, CPB time and circulation assisted time were risk factors for failing to wean from CPB. For the patients who failed to wean from CPB, CABG can provide more excellent short- and mid-term outcomes than ECMO support, which was conditional on not being able to wean off CPB.
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