Interdisciplinary cardiovascular and thoracic surgery · 2025
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.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Zhang Dong, Zhu Gui Jun, Gao Ming Jun, Wei Xiang Yang, Yan Zhe, Li Bin, Chen Xing Peng, Wang Xiao Lin, Shu Yu Sheng
Аннотация
OBJECTIVES: In 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.
METHODS: Two 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).
RESULTS: The 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).
CONCLUSIONS: Preoperative 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.
METHODS: Two 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).
RESULTS: The 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).
CONCLUSIONS: Preoperative 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.