What is the clinical evidence from this study?

Study design: Observational. Population: Patients with acute type A aortic dissection undergoing total arch replacement combined with stented elephant trunk implantation (n=475). Intervention: Cardiopulmonary bypass (CPB) weaning time vs. Shorter CPB weaning time (≤90 minutes) vs prolonged CPB weaning time (>90 minutes). Primary outcome: Postoperative in-hospital death (OR 1.05 per minute increase in CPB weaning time, 95% CI 95% CI 1.02–1.07, p=<0.001).

What question did this study set out to answer?

The aim is to explore how cardiopulmonary bypass weaning time affects postoperative outcomes in aortic dissection surgeries.

February 28, 2026Open Access

Association between cardiopulmonary bypass weaning time and adverse outcomes in patients with aortic dissection who underwent total arch replacement combined with stented elephant trunk implantation

Q: What are the key findings of this study?

Prolonged cardiopulmonary bypass weaning time was associated with increased postoperative in-hospital death with OR 1.05 (95% CI 1.02–1.07) per minute increase and significantly reduced short-term survival in patients with acute type A aortic dissection undergoing total arch replacement.

Q: What question did this study set out to answer?

The aim is to explore how cardiopulmonary bypass weaning time affects postoperative outcomes in aortic dissection surgeries.

Key Result

Prolonged cardiopulmonary bypass weaning time was associated with increased postoperative in-hospital death with OR 1.05 (95% CI 1.02–1.07) per minute increase and significantly reduced short-term survival in patients with acute type A aortic dissection undergoing total arch replacement.

Key Points

The aim is to explore how cardiopulmonary bypass weaning time affects postoperative outcomes in aortic dissection surgeries.
Retrospective enrollment of patients diagnosed with acute type A aortic dissection from 2015 to 2024.
Record and analyze cardiopulmonary bypass weaning time for each patient.
Perform univariate and multivariate logistic regression analyses to evaluate associations.
Use ROC curve analysis to determine the optimal cutoff value for weaning time.
Apply Kaplan-Meier survival analysis to compare survival between stratified groups.
Prolonged CPB weaning time is linked to increased in-hospital death (OR: 1.05; P < 0.001) and stroke (OR: 1.02; P = 0.016).
Optimal cutoff value for weaning time is identified as 90 minutes.
Significant short-term survival differences observed between groups based on weaning time.
No significant mid-term survival differences found across groups.

Study Design

Type

Observational (n=475)

Multicenter

Structured PICO

Does prolonged cardiopulmonary bypass weaning time increase the risk of postoperative in-hospital death and stroke in patients with acute type A aortic dissection undergoing total arch replacement?

Population

475 patients diagnosed with acute type A aortic dissection (ATAAD) who underwent surgical repair (total arch replacement combined with stented elephant trunk implantation) between June 1, 2015, and June 1, 2024.

Intervention

Prolonged cardiopulmonary bypass (CPB) weaning time (evaluated as a continuous variable and with an optimal cutoff of >90 minutes).

Comparator

Shorter cardiopulmonary bypass (CPB) weaning time (≤90 minutes).

Outcome

Postoperative in-hospital death (defined as death from any cause during the hospital stay after surgery).hard clinical

Prolonged cardiopulmonary bypass weaning time (>90 minutes) is an independent predictor of early postoperative mortality and stroke in patients undergoing surgical repair for acute type A aortic dissection.

Main Result

Effect estimate: OR 1.05 per minute increase in CPB weaning time (95% CI 95% CI 1.02–1.07)

p-value: p=<0.001

Limitations

Single-center retrospective design limits generalizability.
Relatively small sample size and potential selection bias due to exclusion of patients with missing data.
Lack of complete adjustment for extent of dissection and branch vessel involvement due to incomplete imaging data.
No detailed data on causes of death or inotropic agent use, which may impact outcomes.
Unable to isolate hemostasis time overlapping with CPB weaning as a separate factor.
Findings may not apply to other CPB procedures beyond type A aortic dissection surgery.

Abstract

Postoperative complications in patients with acute type A aortic dissection (ATAAD) significantly affect their prognosis. This study investigates the association between cardiopulmonary bypass(CPB) weaning time and postoperative adverse outcomes in patients with aortic dissection who underwent total arch replacement combined with stented elephant trunk implantation. Patients diagnosed with ATAAD who underwent surgical repair between June 1, 2015, and June 1, 2024, were retrospectively enrolled. CPB weaning time was recorded for each patient. Univariate and multivariate logistic regression analyses were performed to evaluate the association between CPB weaning time and postoperative adverse outcomes, including death, stroke, and other adverse outcomes. Subgroup analyses were also conducted. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff value of CPB weaning time. Kaplan–Meier survival analysis and log-rank tests were subsequently applied to compare survival between groups stratified by the cutoff value. A total of 475 patients were included in the analysis. Prolonged CPB weaning time was significantly associated with increased postoperative in-hospital death (Odds RatioOR: 1.05; 95% Confidence IntervalCI: 1.02–1.07; P < 0.001) and stroke (OR: 1.02; 95% CI: 1.00–1.03; P = 0.016), but not with other outcomes. The association between CPB weaning time and postoperative in-hospital death remained consistent across subgroups, whereas its association with stroke was influenced by sex, history of coronary heart disease, coronary artery bypass grafting (CABG), axillary artery cannulation, and femoral artery cannulation. The area under the curve (AUC) values of CPB weaning time for predicting postoperative in-hospital death and stroke were 0.844 (95% CI: 0.790–0.899) and 0.670 (95% CI: 0.606–0.734), respectively, with an optimal cutoff value of 90 min. When patients were stratified by this cutoff, a statistically significant difference in short-term survival was observed between the two groups, whereas no significant difference was found in mid-term survival. CPB weaning time is associated with postoperative death and stroke in patients with ATAAD undergoing total arch replacement combined with stented elephant trunk implantation. It is also associated with poor short-term survival but not with mid-term survival, and serve as a predictor of early postoperative risk of mortality in this population.

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