Cardiopulmonary bypass duration is an independent predictor of adverse outcome in surgical repair for acute type A aortic dissection

Objective Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires surgical intervention. This study investigated the relationship between cardiopulmonary bypass (CPB) duration and stroke or early death in ATAAD patients receiving total aortic arch replacement with the frozen elephant trunk procedure (TAR with FET). Methods A retrospective cohort study was conducted at the Beijing Anzhen Hospital from December 2014 to June 2016. Patients receiving TAR with FET for ATAAD were included. CPB duration was recorded during the operation. Adverse outcome (AO) was defined as 30-day mortality or stroke. In total, 258 consecutive patients were ultimately analysed. In addition, as the primary outcome, AO was compared using propensity-matched scoring (PS). Results The incidence of AO was 13.6% (n = 35). The 30-day mortality rate was 10.8%, and the stroke rate was 9.3%. Patients were aged 47.9 ± 10.6 years old and were predominantly male (76.0%). The average CPB duration was 224.3 ± 58.7 min. The duration of CPB was an independent predictor of AO occurrence after adjusting for confounding factors through multivariable logistic regression analysis (OR 1.101, 95% CI 1.003–1.208; P = 0.042). After PS matching, 33 matched pairs were created. In the matched analysis, CPB duration remained an AO risk factor (OR 1.178, 95% CI 1.032–1.345; P = 0.015). Conclusions CPB duration is an independent predictor of adverse outcome in surgical repair for ATAAD. The underlying mechanisms of this association are key for the development of improved prevention strategies.