Short and midterm outcomes of surgical repair of acute type A aortic dissection concomitant CABG vs. ECMO support: A retrospective study

Objective: Intraoperative surgical repair of acute type A aortic dissection, sometimes we would encounter special cases that failed to wean from CPB. In this study, we aimed to retrospectively analyze that the indication, clinical experience and short and midterm outcomes of surgical repair of acute type A aortic dissection concomitant CABG or ECMO support in patients who failed to wean from CPB. Methods: A total of 532 consecutive patients underwent emergent surgery for TAAD in a single institution between Jan 2018 and Jan 2023. And categorized into CABG group and ECMO group based on surgical approach. Preoperative, intraoperative and postoperative variables were assessed and analyzed. Outcomes of the patients were followed up until five years from discharge of hospital. Results: Overall in-hospital mortality was determined to be 15.7% for CABG group and 73.3% for ECMO group (P=0.001). The operation time, CPB time, extracorporeal circulation assisted time, 24-hour traffic diversion in CABG group were less than ECMO group, and had statistically different between two groups (P=0.039, P=0.007, P<0.001, P<0.001). Higher morbidity of delayed chest closure, low cardiac output syndrome, and lower limb osteofascial compartment syndrome in the ECMO group than the CABG group, but not statistically significant (P=0.139, P=1, P=0.524). 5-years follow-up mortality after discharge had no statistically different between two groups (P=1). Conclusion: For the patients who failed to wean from CPB, surgical repair of acute type A aortic dissection Concomitant CABG can provide more excellent short and midterm outcomes than ECMO support. However, concomitant CABG are also associated with long-term complications of the great saphenous vein embolization and severe tricuspid valve regurgitation. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement None ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This observational study was approved by the Ethics committee of Yangzhou University Affiliated Northern Jiangsu People's Hospital I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available from the corresponding author upon reasonable request.