Objectives: In this study, we aimed to retrospectively analyze that the risk factors for failing to wean from CPB and short-midterm outcomes of surgical repair of acute TAAD concomitant CABG versus ECMO support in patients.
Methods: 203 patients were enrolled and categorized into simple TAAD group (n = 106) and complex TAAD group (n = 97). Following propensity score matching, 68 patients in complex TAAD group were distributed between the CABG subgroup (n = 34) and ECMO subgroup (n = 34) for further analysis. Five-year survival were analyzed using Kaplan-Meier method. Multivariable logistic regression analysis was used to identify independent risk factors for failing to wean from CPB.
Results: The complex TAAD group had higher in-hospital mortality than simple TAAD group (29.9% vs 16.9%, P = 0.049). Multivariable analysis revealed that preoperative high-value cTnI, 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). There was no significant difference in in-hospital mortality between 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 ECMO subgroup, with a statistically significant difference (log-rank P = 0.04).
Conclusions: Preoperative high-value cTnI, 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 midterm outcomes than ECMO support, which was conditional on not being able to wean off CPB.
Keywords: CABG; ECMO; acute type A aortic dissection; outcomes; repair.
© Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery 2025.