Cardiopulmonary Bypass Time During Surgery for Acute Type A Aortic Dissection and Mid-Term Survival

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Research

Background:

• Acute type A aortic dissection (ATAAD) is a life-threatening condition requiring urgent surgical repair.
• Cardiopulmonary bypass (CPB) is essential for surgical intervention but may impact patient outcomes.
• The relationship between CPB duration and survival after ATAAD repair requires further elucidation.

Purpose of the Study:

• To evaluate the association between cardiopulmonary bypass (CPB) time and mid-term survival in patients undergoing surgery for ATAAD.
• To investigate the impact of CPB duration on 30-day mortality and reoperation-free survival.

Main Methods:

• Retrospective analysis of 1122 patients with ATAAD from eight Nordic centers (2005-2014).
• Adjusted logistic regression for 30-day mortality and restricted mean survival time ratios for mid-term survival.
• Spline analysis and ROC curve determined a CPB time threshold of 210 minutes for group comparison.

Main Results:

• Each 30-minute increase in CPB time was associated with a 25% higher risk of 30-day mortality (OR 1.25, p < 0.001).
• Mid-term survival was significantly inferior in patients with CPB time >210 minutes compared to <210 minutes (adjusted RMSTR 0.88, p = 0.003).
• Reoperation-free survival was similar between the two CPB time groups.

Conclusions:

• Prolonged CPB time (>210 minutes) is an independent risk factor for increased 30-day mortality after ATAAD surgery.
• Extended CPB duration is linked to poorer mid-term survival but does not affect the need for reoperation.
• Optimizing CPB strategies may improve outcomes for ATAAD patients.