Datasheet1_Acute type A aortic dissection in patients with non-prior cardiac surgery vs. prior cardiac surgery: a systematic review and meta-analysis.docx

BackgroundPatients 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.
AimTo compare the safety and efficacy of ATAAD in patients with prior cardiac surgery.
MethodsWe 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.
ResultsOur 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.
ConclusionPatients 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.

研究背景：既往接受过心脏手术的急性A型主动脉夹层（acute type A aortic dissection, ATAAD）患者，其临床预后普遍被认为较未接受过心脏手术的同类患者更差。
研究目的：对比既往接受过心脏手术的ATAAD患者与未接受过心脏手术的同类患者的治疗安全性与有效性。
研究方法：本研究系统检索了PubMed、科克伦图书馆（Cochrane Library）及谷歌学术自建库至2024年4月的相关文献。最终纳入9项研究，其研究人群包括既往手术组524例患者与非既往手术组5249例患者。本研究的主要结局指标为死亡率。次要结局指标包括出血再手术、心肌梗死、脑卒中、肾衰竭、胸骨切口感染、体外循环（cardiopulmonary bypass, CPB）时长、主动脉阻断时长、住院时长以及ICU停留时长。
研究结果：合并效应量分析显示，非既往心脏手术组的死亡率显著低于既往心脏手术组（相对危险度（Relative Risk, RR）=0.60，95%置信区间（Confidence Interval, CI）=0.48~0.74）。在次要结局指标中，非既往心脏手术组的出血再手术率显著更低（RR=0.66，95%CI=0.50~0.88）。此外，非既往心脏手术组的CPB时长（均数差（Mean Difference, MD）=-31.06，95%CI=-52.20~-9.93）与主动脉阻断时长（MD=-21.95，95%CI=-42.65~-1.24）均显著更短。其余所有次要结局指标均无统计学显著性差异。
研究结论：既往接受过心脏手术的ATAAD患者，其死亡率较未接受过心脏手术的同类患者更高。既往接受过心脏手术的患者死亡率更高，CPB时长与主动脉阻断时长也更长。针对这一高危人群，需制定个体化诊疗策略以优化其临床预后。