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SYSTEMATIC REVIEW article

Front. Cardiovasc. Med.
Sec. Aortic Surgery and Endovascular Repair Archive
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1438556

Acute Type A Aortic Dissection in Patients with Non-Prior Cardiac Surgery vs Prior Cardiac Surgery: A Systematic Review and Meta-Analysis

Provisionally accepted
Muhammad Ahmed Muhammad Ahmed 1Hafsah Alim Ur Rahman Hafsah Alim Ur Rahman 2Muhammad Ahmed Ali Fahim Muhammad Ahmed Ali Fahim 2Zahabia A. Hussain Zahabia A. Hussain 2Nisar Ahmed Nisar Ahmed 3Muhammad Sohaib Asghar Muhammad Sohaib Asghar 4*
  • 1 Benazir Bhutto Shaheed University Lyari, Karachi, Sindh, Pakistan
  • 2 Dow Medical College, Dow University of Health Sciences, Karachi, Punjab, Pakistan
  • 3 Rapides Regional Medical Center, Alexandria, Louisiana, United States
  • 4 AdventHealth, Orlando, United States

The final, formatted version of the article will be published soon.

    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 to 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 to 0.88). Additionally, the nonprior cardiac surgery group had significantly shorter CPB time (MD= -31.06, 95% CI= -52.20 to -9.93) and cross-clamp time . 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.

    Keywords: aortic dissection, cardiac surgery, Metanalysis, Systematic literature search, PRISMA

    Received: 26 May 2024; Accepted: 31 Jul 2024.

    Copyright: © 2024 Ahmed, Alim Ur Rahman, Fahim, Hussain, Ahmed and Asghar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Muhammad Sohaib Asghar, AdventHealth, Orlando, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.