{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:58:32Z","timestamp":1788562712352,"version":"build-2803163510"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T00:00:00Z","timestamp":1724630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To compare the safety and efficacy of ATAAD in patients with prior cardiac surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our pooled estimate shows a significantly lower rate of mortality in the non-prior cardiac surgery group compared to the prior cardiac surgery group (RR\u2009=\u20090.60, 95% CI\u2009=\u20090.48\u20130.74). Among the secondary outcomes, the rate of reoperation for bleeding was significantly lower in the non-prior cardiac surgery group (RR\u2009=\u20090.66, 95% CI\u2009=\u20090.50\u20130.88). Additionally, the non-prior cardiac surgery group had significantly shorter CPB time (MD\u2009=\u2009\u221231.06, 95% CI\u2009=\u2009\u221252.20 to \u22129.93) and cross-clamp time (MD\u2009=\u2009\u221221.95, 95% CI\u2009=\u2009\u221242.65 to \u22121.24). All other secondary outcomes were statistically insignificant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2024.1438556","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T04:31:13Z","timestamp":1724646673000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Acute type A aortic dissection in patients with non-prior cardiac surgery vs. prior cardiac surgery: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"11","author":[{"given":"Muhammad","family":"Ahmed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafsah","family":"Alim Ur Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Ahmed Ali","family":"Fahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahabia Altaf","family":"Hussain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisar","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Sohaib","family":"Asghar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/nrdp.2016.53","article-title":"Aortic dissection","volume":"2","author":"Nienaber","year":"2016","journal-title":"Nat Rev Dis Prim"},{"key":"B2","doi-asserted-by":"publisher","first-page":"w14489","DOI":"10.4414\/smw.2017.14489","article-title":"Acute aortic dissection: pathogenesis, risk factors and diagnosis","volume":"147","author":"Gawinecka","year":"2017","journal-title":"Swiss Med Wkly"},{"key":"B3","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1002\/jhrm.5600250206","article-title":"Case studies in acute aortic dissection: strategies to avoid a catastrophic outcome","volume":"25","author":"Sixsmith","year":"2005","journal-title":"J Healthc Risk Manag"},{"key":"B4","year":"2024","journal-title":"StatPearls [Internet]"},{"key":"B5","first-page":"171","article-title":"Aortic dissection","author":"Saric","year":"2010","journal-title":"Dyn Echocardiogr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"S175","DOI":"10.1161\/CIRCULATIONAHA.112.000327","article-title":"Stroke and outcomes in patients with acute type A aortic dissection","volume":"128","author":"Bossone","year":"2013","journal-title":"Circulation"},{"key":"B7","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.nrl.2016.02.001","article-title":"Ischaemic stroke secondary to aortic dissection: a diagnostic challenge","volume":"33","author":"Mu\u00f1iz Castrillo","year":"2018","journal-title":"Neurol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1097\/CP9.0000000000000028","article-title":"Aortic dissection: global epidemiology","volume":"7","author":"Yin","year":"2022","journal-title":"Cardiol Plus"},{"key":"B9","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1093\/eurheartj\/ehab586","article-title":"Determinants of outcomes following surgery for type A acute aortic dissection: the UK national adult cardiac surgical audit","volume":"43","author":"Benedetto","year":"2022","journal-title":"Eur Heart J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1602","DOI":"10.1161\/CIRCULATIONAHA.113.002603","article-title":"Type a aortic dissection after nonaortic cardiac surgery","volume":"128","author":"Stanger","year":"2013","journal-title":"Circulation"},{"key":"B11","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/S0022-5223(99)70420-4","article-title":"Dissection of the ascending aorta after previous cardiac surgery: differences in presentation and management","volume":"117","author":"Gillinov","year":"1999","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"101991","DOI":"10.1016\/j.cpcardiol.2023.101991","article-title":"Impact of previous cardiac operations in patients undergoing surgery for type A acute aortic dissection. 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