Zhang Dong, Zhu Gui Jun, Gao Ming Jun, Wei Xiang Yang, Yan Zhe, Li Bin, Chen Xing Peng, Wang Xiao Lin, Shu Yu Sheng
Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
Department of Cardiothoracic Surgery, Luoyang Central Hospital, Luoyang, China.
Interdiscip Cardiovasc Thorac Surg. 2025 Jul 3;40(7). doi: 10.1093/icvts/ivaf128.
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.
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).
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).
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.
在本研究中，我们旨在回顾性分析急性A型主动脉夹层（TAAD）手术修复及同期冠状动脉旁路移植术（CABG）与体外膜肺氧合（ECMO）支持下患者脱离体外循环（CPB）失败的危险因素以及短期和中期结局。
纳入203例患者，分为单纯TAAD组（n = 106）和复杂TAAD组（n = 97）。经过倾向得分匹配后，将复杂TAAD组中的68例患者分配至CABG亚组（n = 34）和ECMO亚组（n = 34）进行进一步分析。采用Kaplan-Meier法分析5年生存率。多变量逻辑回归分析用于确定脱离体外循环（CPB）失败的独立危险因素。
复杂TAAD组的院内死亡率高于单纯TAAD组（29.9%对16.9%，P = 0.049）。多变量分析显示，术前高值心肌肌钙蛋白I、手术时间、CPB时间和循环辅助时间是脱离CPB失败的危险因素（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）。CABG亚组和ECMO亚组的院内死亡率无显著差异（5.9%对20.6%，P = 0.15）。相比之下，CABG亚组的5年总生存率与ECMO亚组相比有显著改善，差异有统计学意义（对数秩检验P = 0.04）。
术前高值心肌肌钙蛋白I、手术时间、CPB时间和循环辅助时间是脱离CPB失败的危险因素。对于未能脱离CPB的患者，CABG比ECMO支持能提供更优的短期和中期结局，这是以无法脱离CPB为条件的。
