AI Article Synopsis
- Patients with prior cardiac surgery facing acute type A aortic dissection (ATAAD) have worse clinical outcomes, particularly a higher mortality rate compared to those without prior surgery.
- A systematic review of nine studies revealed significant differences in outcomes, including a notable reduction in mortality and reoperation rates for the non-prior surgery group.
- The findings suggest that individuals with prior cardiac surgery experience longer cardiopulmonary bypass (CPB) and cross-clamp times, indicating a need for specialized strategies to enhance their treatment outcomes.
Article Abstract
Background: Patients with prior cardiac surgery undergoing acute type A aortic dissection (ATAAD) are thought to have worse clinical outcomes as compared to the patients without prior cardiac surgery.
Aim: To compare the safety and efficacy of ATAAD in patients with prior cardiac surgery.
Methods: We systematically searched PubMed, Cochrane Library and Google Scholar from database inception until April 2024. We included nine studies which consisted of a population of 524 in the prior surgery group and 5,249 in the non-prior surgery group. Our primary outcome was mortality. Secondary outcomes included reoperation for bleeding, myocardial infarction, stroke, renal failure, sternal wound infection, cardiopulmonary bypass (CPB) time, cross-clamp time, hospital stay, and ICU stay.
Results: Our pooled estimate shows a significantly lower rate of mortality in the non-prior cardiac surgery group compared to the prior cardiac surgery group (RR = 0.60, 95% CI = 0.48-0.74). Among the secondary outcomes, the rate of reoperation for bleeding was significantly lower in the non-prior cardiac surgery group (RR = 0.66, 95% CI = 0.50-0.88). Additionally, the non-prior cardiac surgery group had significantly shorter CPB time (MD = -31.06, 95% CI = -52.20 to -9.93) and cross-clamp time (MD = -21.95, 95% CI = -42.65 to -1.24). All other secondary outcomes were statistically insignificant.
Conclusion: Patients with prior cardiac surgery have a higher mortality rate as compared to patients who have not undergone cardiac surgery previously. Patients with prior cardiac surgery have higher mortality and longer CPB and cross-clamp times. Tailored strategies are needed to improve outcomes in this high-risk group.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11381269 | PMC |
| http://dx.doi.org/10.3389/fcvm.2024.1438556 | DOI Listing |
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