Is Prior Cardiac Surgery a Risk Factor for Patients in Aortic Surgery: A Systematic Review and Meta-analysis.
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| Titel: | Is Prior Cardiac Surgery a Risk Factor for Patients in Aortic Surgery: A Systematic Review and Meta-analysis. |
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| Autoren: | Lang Q; Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Zhang J; Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Li J; Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Xiao Z; Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Meng W; Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Qin C; Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: qinchaoyi@wchscu.edu.cn. |
| Quelle: | Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2025 Nov; Vol. 39 (11), pp. 3163-3172. Date of Electronic Publication: 2025 Jul 02. |
| Publikationsart: | Journal Article; Systematic Review; Meta-Analysis; Review |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: W.B. Saunders Country of Publication: United States NLM ID: 9110208 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8422 (Electronic) Linking ISSN: 10530770 NLM ISO Abbreviation: J Cardiothorac Vasc Anesth Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Philadelphia, PA : W.B. Saunders, c1991- |
| MeSH-Schlagworte: | Cardiac Surgical Procedures*/adverse effects , Cardiac Surgical Procedures*/trends , Postoperative Complications*/epidemiology , Sternotomy*/adverse effects , Sternotomy*/trends, Humans ; Risk Factors ; Hospital Mortality/trends ; Reoperation/trends |
| Abstract: | Competing Interests: Declaration of competing interest The authors declare that they have no competing interests. Background: The rising global incidence of aortic surgical interventions has increased demand for complex reoperations. However, surgical outcomes between primary aortic surgery (PAS) and repeat sternotomy aortic surgery (RAS) remain poorly characterized. This study was designed to evaluate whether prior cardiac surgery constitutes a risk factor for patients undergoing aortic surgery. Methods: A systematic search of PubMed, Embase, and Web of Science was conducted to identify studies comparing surgical outcomes between PAS and RAS. The primary outcome was in-hospital mortality. Secondary outcomes included the incidence of re-exploration for bleeding, renal failure, deep sternal wound infection, neurologic events, cardiopulmonary bypass time, and long-term survival rates at 2-year, 4-year, 8-year, and 10-year follow-ups. Results: A total of 19 studies involving 31,631 participants were included in this meta-analysis. Patients undergoing PAS demonstrated significantly lower rates of in-hospital mortality (9.3% v 16.0%, odds ratio [OR] 0.55, 95% confidence interval [CI] 0.50-0.60; I 2 = 0.0%, p < 0.001) compared with the RAS cohort. PAS was also associated with a lower incidence of re-exploration for bleeding (7.2% v 9.4%, OR 0.76, 95% CI 0.68-0.84, p < 0.001), renal failure (13.3% v 15.8%, OR 0.73, 95% CI 0.65-0.81, p < 0.001), and deep sternal wound infection (0.7% v 2.8%, OR 0.47, 95% CI 0.37-0.60, p < 0.001). In anatomical subgroup analyses, patients undergoing primary aortic root surgery demonstrated significantly lower mortality odds compared with repeat sternotomy root procedures (5.0% v 8.4%, OR 0.55, 95% CI 0.50-0.61, p < 0.001); while primary aortic arch surgery demonstrated a mortality benefit compared with repeat sternotomy for arch interventions, this advantage was less pronounced than that observed in root procedures (8.4% v 11.9%, OR 0.60, 95% CI 0.39-0.94, p = 0.026). While short-term survival favored the PAS group (62.6% v 55.2%, 2-year OR 0.74, 95% CI 0.58-0.93, p = 0.01), long-term survival converged between groups (14.8% v 12.7%, 10-year OR 0.82, 95% CI 0.60-1.13, p = 0.23), particularly after propensity score matching. Conclusion: This study shows that RAS is associated with significantly elevated in-hospital mortality and increased perioperative risks, particularly pronounced in repeat sternotomy root replacement procedures. However, prior cardiac surgery did not diminish the long-term benefits of aortic surgery. (Copyright © 2025 Elsevier Inc. All rights reserved.) |
| Contributed Indexing: | Keywords: clinical outcomes; meta-analysis; primary aortic surgery; repeat sternotomy aortic surgery |
| Entry Date(s): | Date Created: 20250724 Date Completed: 20251012 Latest Revision: 20251120 |
| Update Code: | 20251121 |
| DOI: | 10.1053/j.jvca.2025.06.056 |
| PMID: | 40707340 |
| Datenbank: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Competing Interests: Declaration of competing interest The authors declare that they have no competing interests.<br />Background: The rising global incidence of aortic surgical interventions has increased demand for complex reoperations. However, surgical outcomes between primary aortic surgery (PAS) and repeat sternotomy aortic surgery (RAS) remain poorly characterized. This study was designed to evaluate whether prior cardiac surgery constitutes a risk factor for patients undergoing aortic surgery.<br />Methods: A systematic search of PubMed, Embase, and Web of Science was conducted to identify studies comparing surgical outcomes between PAS and RAS. The primary outcome was in-hospital mortality. Secondary outcomes included the incidence of re-exploration for bleeding, renal failure, deep sternal wound infection, neurologic events, cardiopulmonary bypass time, and long-term survival rates at 2-year, 4-year, 8-year, and 10-year follow-ups.<br />Results: A total of 19 studies involving 31,631 participants were included in this meta-analysis. Patients undergoing PAS demonstrated significantly lower rates of in-hospital mortality (9.3% v 16.0%, odds ratio [OR] 0.55, 95% confidence interval [CI] 0.50-0.60; I <sup>2</sup> = 0.0%, p < 0.001) compared with the RAS cohort. PAS was also associated with a lower incidence of re-exploration for bleeding (7.2% v 9.4%, OR 0.76, 95% CI 0.68-0.84, p < 0.001), renal failure (13.3% v 15.8%, OR 0.73, 95% CI 0.65-0.81, p < 0.001), and deep sternal wound infection (0.7% v 2.8%, OR 0.47, 95% CI 0.37-0.60, p < 0.001). In anatomical subgroup analyses, patients undergoing primary aortic root surgery demonstrated significantly lower mortality odds compared with repeat sternotomy root procedures (5.0% v 8.4%, OR 0.55, 95% CI 0.50-0.61, p < 0.001); while primary aortic arch surgery demonstrated a mortality benefit compared with repeat sternotomy for arch interventions, this advantage was less pronounced than that observed in root procedures (8.4% v 11.9%, OR 0.60, 95% CI 0.39-0.94, p = 0.026). While short-term survival favored the PAS group (62.6% v 55.2%, 2-year OR 0.74, 95% CI 0.58-0.93, p = 0.01), long-term survival converged between groups (14.8% v 12.7%, 10-year OR 0.82, 95% CI 0.60-1.13, p = 0.23), particularly after propensity score matching.<br />Conclusion: This study shows that RAS is associated with significantly elevated in-hospital mortality and increased perioperative risks, particularly pronounced in repeat sternotomy root replacement procedures. However, prior cardiac surgery did not diminish the long-term benefits of aortic surgery.<br /> (Copyright © 2025 Elsevier Inc. All rights reserved.) |
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| ISSN: | 1532-8422 |
| DOI: | 10.1053/j.jvca.2025.06.056 |