Intraoperative Parameters and Postoperative Outcomes in Ascending Aortic Surgery: A Comparative Study of Elective and Emergency Interventions — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Intraoperative Parameters and Postoperative Outcomes in Ascending Aortic Surgery: A Comparative Study of Elective and Emergency Interventions
Department of Cardiovascular Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
,
Department of Psychiatry, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
,
Faculty of Medicine, European University Callos, Tuzla, Bosnia and Herzegovina
1 Department of Cardiovascular Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
2 Department of Psychiatry, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
3 Faculty of Medicine, European University Callos, Tuzla, Bosnia and Herzegovina
Background: Ascending aortic aneurysms and acute type A dissections remain life-threatening conditions requiring urgent or elective surgical repair. Emergency procedures are associated with substantially higher perioperative morbidity and mortality compared to elective interventions, primarily due to hemodynamic instability, prolonged operative times, and systemic inflammatory response. Methods: Retrospective-prospective cohort study included 100 consecutive patients who underwent ascending aortic reconstruction at the University Clinical Center Tuzla. Patients were divided into elective (Group I, n = 50) and emergency (Group II, n = 50) cohorts. Collected variables encompassed demographics, comorbidities, intraoperative parameters (cardiopulmonary bypass [CPB], aortic cross-clamp [ACC], and hypothermic circulatory arrest [HCA] durations), postoperative complications (respiratory, cardiac, renal, surgical), and in-hospital mortality. Statistical comparisons were performed using independent t-tests for continuous variables, chi-square tests for categorical data, and univariate analysis for correlations (significance level p < 0.05). Results: Emergency patients presented with significantly higher rates of preoperative shock (82% vs. 0%), renal insufficiency (42% vs. 6%), and redo procedures (38% vs. 2%). Intraoperative times were markedly prolonged in Group II: CPB (235.38 ± 90.85 min vs. 166.57 ± 31.33 min; p = 0.006), ACC (191.79 ± 42.39 min vs. 143.45 ± 30.80 min; p = 0.002). Postoperative complication rates were substantially elevated in emergencies: respiratory (38% vs. 20%; p = 0.049), cardiac (70% vs. 18%; p = 0.015), renal (48% vs. 16%; p = 0.027). Prolonged CPB (>180 min) and HCA (>30 min) were independently associated with increased cardiac and renal morbidity. In-hospital mortality reached 13% overall (28% in emergencies vs. 2% in electives; p < 0.001), predominantly linked to preoperative shock (86.7% of fatal cases). Conclusions: Emergency ascending aortic surgery carries a significantly higher burden of postoperative complications and mortality compared to elective repair. Strategies aimed at rapid patient stabilization, minimization of CPB and HCA durations, and enhanced perioperative organ protection are essential to narrow the outcome gap between elective and acute presentations.
KeywordsAscending Aortic AneurysmType A Aortic DissectionCardiopulmonary BypassHypothermic Circulatory Arrest
World Health Organization (2026) Cardiovascular Diseases (CVDs). https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
Roth, G.A., Mensah, G.A., Johnson, C.O., Addolorato, G., Ammirati, E., Baddour, L.M., et al . (2020) Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019. Journal of the American College of Cardiology , 76, 2982-3021. https://doi.org/10.1016/j.jacc.2020.11.010
Evangelista, A., Isselbacher, E.M., Bossone, E., Gleason, T.G., Eusanio, M.D., Sechtem, U., et al . (2018) Insights from the International Registry of Acute Aortic Dissection. Circulation , 137, 1846-1860. https://doi.org/10.1161/circulationaha.117.031264
Erbel, R., Aboyans, V., Boileau, C., et al . (2014) 2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases: Document Covering Acute and Chronic Aortic Diseases of the Thoracic and Abdominal Aorta of the Adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). European Heart Journal , 35, 2873-2926. https://doi.org/10.1093/eurheartj/ehu281
Nienaber, C.A. and Eagle, K.A. (2003) Aortic Dissection: New Frontiers in Diagnosis and Management. Circulation , 108, 628-635. https://doi.org/10.1161/01.cir.0000087009.16755.e4
Hiratzka, L.F., Bakris, G.L., Beckman, J.A., Bersin, R.M., Carr, V.F., Casey, D.E., et al . (2010) 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease. Circulation , 121, e266-e369. https://doi.org/10.1161/cir.0b013e3181d4739e
Isselbacher, E.M., Preventza, O., Black, J.H., et al . (2022) Correction to: 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 146, e334-e482. https://doi.org/10.1161/CIR.0000000000001097
Ross, R. (1999) Atherosclerosis—An Inflammatory Disease. New England Journal of Medicine , 340, 115-126. https://doi.org/10.1056/nejm199901143400207
Wolf, D. and Ley, K. (2019) Immunity and Inflammation in Atherosclerosis. Circulation Research , 124, 315-327. https://doi.org/10.1161/circresaha.118.313591
Postoperative Complications
Emergency Surgery
Damberg, A., Carino, D., Charilaou, P., et al . (2021) Critical Thresholds of Hypothermic Circulatory Arrest Duration for Adverse Neurologic Outcome in Aortic Surgery. Journal of Thoracic and Cardiovascular Surgery , 162, 760-769.
Karkouti, K., Wijeysundera, D.N., Yau, T.M., Callum, J.L., Cheng, D.C., Crowther, M., et al . (2009) Acute Kidney Injury after Cardiac Surgery. Circulation , 119, 495-502. https://doi.org/10.1161/circulationaha.108.786913
Paparella, D., Yau, T.M. and Young, E. (2002) Cardiopulmonary Bypass Induced Inflammation: Pathophysiology and Effects of Complement Inhibition. Annals of Thoracic Surgery , 73, 1941-1950.
Conzelmann, L.O., Weigang, E., Mehlhorn, U., Abugameh, A., Hoffmann, I., Blettner, M., et al . (2015) Mortality in Patients with Acute Aortic Dissection Type A: Analysis of Pre-and Intraoperative Risk Factors from the German Registry for Acute Aortic Dissection Type a (Geraada). European Journal of Cardio - Thoracic Surgery , 49, e44-e52. https://doi.org/10.1093/ejcts/ezv356
Booher, A.M., Isselbacher, E.M., Nienaber, C.A., Trimarchi, S., Evangelista, A., Montgomery, D.G., et al . (2013) The IRAD Classification System for Characterizing Survival after Aortic Dissection. The American Journal of Medicine , 126, 730.e19-730.e24. https://doi.org/10.1016/j.amjmed.2013.01.020
Czerny, M., Conzelmann, L.O., Dierks, P., et al . (2017) German Registry for Acute Aortic Dissection Type A: Structure, Results, and Future Perspectives. Thoracic and Cardiovascular Surgery , 65, 1-8.
Biancari, F., Mariscalco, G., Mariani, S., et al . (2022) Contemporary Results after Surgical Repair of Type A Aortic Dissection: A Systematic Review. Journal of Thoracic and Cardiovascular Surgery , 164, 1742-1754.
Etz, C.D., Bischoff, M.S., Bodian, C., Roder, F., Brenner, R., Griepp, R.B., et al . (2010) The Bentall Procedure: Is It the Gold Standard? A Series of 597 Consecutive Cases. The Journal of Thoracic and Cardiovascular Surgery , 140, S64-S70. https://doi.org/10.1016/j.jtcvs.2010.07.033
Wan, S., DeSmet, J., Barvais, L., Goldstein, M., Vincent, J. and LeClerc, J. (1996) Myocardium Is a Major Source of Proinflammatory Cytokines in Patients Undergoing Cardiopulmonary Bypass. The Journal of Thoracic and Cardiovascular Surgery , 112, 806-811. https://doi.org/10.1016/s0022-5223(96)70068-5
Royston, D. (1992) High-Dose Aprotinin Therapy: A Review of the First Five Years’ Experience. Journal of Cardiothoracic and Vascular Anesthesia , 6, 76-100. https://doi.org/10.1016/1053-0770(91)90052-u
Trimarchi, S., Nienaber, C.A., Rampoldi, V., Myrmel, T., Suzuki, T., Mehta, R.H., et al . (2005) Contemporary Results of Surgery in Acute Type a Aortic Dissection: The International Registry of Acute Aortic Dissection Experience. The Journal of Thoracic and Cardiovascular Surgery , 129, 112-122. https://doi.org/10.1016/j.jtcvs.2004.09.005
Urbanski, P.P., Lenos, A., Bougioukakis, P., et al . (2012) Mild-to-Moderate Hypothermia during Elective Aortic Arch Surgery Improves Outcome. European Journal of Cardio - Thoracic Surgery , 41, 491-495.
Elefteriades, J.A. and Ziganshin, B.A. (2021) Thoracic Aortic Aneurysm: A Review of Epidemiology, Risk Factors, and Management. Journal of the American College of Cardiology , 77, 1845-1858.
Roselli, E.E., Pettersson, G., Blackstone, E.H., et al . (2008) Adverse Events during Roperative Aortic Valve Replacement: Effect of Previous Coronary Artery Bypass Grafting. Annals of Thoracic Surgery , 85, 969-977.
Ng, C.S.H., Wan, S., Yim, A.P.C. and Arifi, A.A. (2002) Pulmonary Dysfunction after Cardiac Surgery. Chest , 121, 1269-1277. https://doi.org/10.1378/chest.121.4.1269
Etz, C.D., Plestis, K.A., Kari, F.A., Luehr, M., Bodian, C.A., Spielvogel, D., et al . (2008) Staged Repair of Thoracic and Thoracoabdominal Aortic Aneurysms Using the Elephant Trunk Technique: A Consecutive Series of 215 First Stage and 120 Complete Repairs☆. European Journal of Cardio - Thoracic Surgery , 34, 605-615. https://doi.org/10.1016/j.ejcts.2008.04.045
Harris, K.M., Strauss, C.E., Eagle, K.A., et al . (2013) Acute Aortic Dissection: Insights from the International Registry of Acute Aortic Dissection (IRAD). Current Cardiology Reports , 15, 379.
Olsson, C. and Franco-Cereceda, A. (2013) Impact of Organ Failure and Major Complications on Outcome in Acute Type a Aortic Dissection. Scandinavian Cardiovascular Journal , 47, 352-358. https://doi.org/10.3109/14017431.2013.845307
Zierer, A., Risteski, P., El-Sayed Ahmad, A., et al . (2016) The Impact of Moderate-to-Deep versus Mild Hypothermia on Long-Term Survival after Elective Aortic Hemiarch Replacement. European Journal of Cardio - Thoracic Surgery , 50, 1047-1053.