Short and midterm outcomes of surgical repair of acute type A aortic dissection concomitant CABG vs. ECMO support: A retrospective study

Abstract

ObjectiveIntraoperative surgical repair of acute type A aortic dissection, sometimes we would encounter special cases that failed to wean from CPB. In this study, we aimed to retrospectively analyze that the indication, clinical experience and short and midterm outcomes of surgical repair of acute type A aortic dissection concomitant CABG or ECMO support in patients who failed to wean from CPB.MethodsA total of 532 consecutive patients underwent emergent surgery for TAAD in a single institution between Jan 2018 and Jan 2023. And categorized into CABG group and ECMO group based on surgical approach. Preoperative, intraoperative and postoperative variables were assessed and analyzed. Outcomes of the patients were followed up until five years from discharge of hospital.ResultsOverall in-hospital mortality was determined to be 15.7% for CABG group and 73.3% for ECMO group (P=0.001). The operation time, CPB time, extracorporeal circulation assisted time, 24-hour traffic diversion in CABG group were less than ECMO group, and had statistically different between two groups (P=0.039,P=0.007,P<0.001,P<0.001). Higher morbidity of delayed chest closure, low cardiac output syndrome, and lower limb osteofascial compartment syndrome in the ECMO group than the CABG group, but not statistically significant (P=0.139,P=1,P=0.524).5-years follow-up mortality after discharge had no statistically different between two groups (P=1).ConclusionFor the patients who failed to wean from CPB, surgical repair of acute type A aortic dissection Concomitant CABG can provide more excellent short and midterm outcomes than ECMO support. However, concomitant CABG are also associated with long-term complications of the great saphenous vein embolization and severe tricuspid valve regurgitation.