{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:14Z","timestamp":1787028614459,"version":"build-2736575974"},"reference-count":23,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital"},{"name":"Finnish Cultural Foundation from Pirkanmaa Regional Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>We evaluated the association between cardiopulmonary bypass (CPB) time during surgery for acute type A aortic dissection (ATAAD) and mid-term survival. Data of 1122 patients who underwent surgery for ATAAD in eight Nordic centers from January 2005 to December 2014 were retrospectively analyzed. An adjusted logistic regression analysis was performed to investigate the association of incremental 30 min CPB time on 30-day mortality. In addition, the patients were divided into those that underwent surgery with &gt;210 min (n = 369) or &lt;210 min CPB time (n = 605) based on spline analysis and a receiver operating characteristic curve. The restricted mean survival time ratios adjusted for patient characteristics and surgical details between the groups were calculated for survival and aortic reoperation-free survival. The median follow-up time was 2.6 (inter-quartile range 0.9\u20134.9) years. Incremental CPB time was associated with higher 30-day mortality (OR 1.25 per 30 min, 95% CI 1.15\u20131.35, p &lt; 0.001). Mid-term survival for all patients was inferior in the &gt;210 min group as compared with the &lt;210 min group (adjusted restricted mean survival time ratio 0.88, 95% confidence interval [CI] 0.81\u20130.96, p = 0.003). Reoperation-free survival was similar in patients with CPB time &gt; 210 min as compared with &lt;210 min. Prolonged CPB time is associated with higher 30-day mortality and inferior mid-term survival but not with inferior reoperation-free survival after surgical repair of ATAAD.<\/jats:p>","DOI":"10.3390\/jcdd12040139","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T20:43:17Z","timestamp":1745440997000},"page":"139","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiopulmonary Bypass Time During Surgery for Acute Type A Aortic Dissection and Mid-Term Survival"],"prefix":"10.3390","volume":"12","author":[{"given":"Mikko","family":"Uimonen","sequence":"first","affiliation":[{"name":"Tampere University Hospital, Heart Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Olsson","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital, SE-17176 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2356-2295","authenticated-orcid":false,"given":"Anders","family":"Jeppsson","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden"},{"name":"Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnar","family":"Geirsson","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vibeke","family":"Hjortdal","sequence":"additional","affiliation":[{"name":"Aarhus University Hospital, DK-8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3083-0860","authenticated-orcid":false,"given":"Emma C.","family":"Hansson","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden"},{"name":"Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Zindovic","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Clinical Sciences, Sk\u00e5ne University, Lund University, 22100 Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Ede","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Clinical Sciences, Sk\u00e5ne University, Lund University, 22100 Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarmo","family":"Gunn","sequence":"additional","affiliation":[{"name":"Turku University Hospital, 20521 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7447-8996","authenticated-orcid":false,"given":"Anders","family":"Wickbom","sequence":"additional","affiliation":[{"name":"Orebro University Hospital, 70116 Orebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Gudbjartsson","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5082-4161","authenticated-orcid":false,"given":"Ari","family":"Mennander","sequence":"additional","affiliation":[{"name":"Tampere University Hospital, Heart Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1093\/ehjacc\/zuab031","article-title":"Population-based incidence and outcomes of acute aortic dissection in Japan","volume":"10","author":"Yamaguchi","year":"2021","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"zraf003","DOI":"10.1093\/bjsopen\/zraf003","article-title":"Extent of surgical repair and outcomes after surgery for type A aortic dissection","volume":"10","author":"Biancari","year":"2025","journal-title":"BJS Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.ijcard.2018.05.111","article-title":"Acute type A aortic dissection: Rationale and outcomes of extensive repair of the arch and distal aorta","volume":"267","author":"Leone","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1053\/j.semtcvs.2020.06.025","article-title":"Contemporary Surgical Strategies for Acute Type A Aortic Dissection","volume":"32","author":"Frankel","year":"2020","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s11748-018-0957-3","article-title":"How should we manage type A aortic dissection?","volume":"67","author":"Jassar","year":"2019","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s13019-019-1007-7","article-title":"Extensive aortic surgery in acute aortic dissection type A on outcome\u2013insights from 25 years single center experience","volume":"14","author":"Dib","year":"2019","journal-title":"J. Cardiothor. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1093\/ejcts\/ezs025","article-title":"Analysis of risk factors for neurological dysfunction in patients with acute aortic dissection type A: Data from the German Registry for Acute Aortic Dissection type A (GERAADA)","volume":"42","author":"Conzelmann","year":"2012","journal-title":"Eur. J. Cardiothor. Surg."},{"key":"ref_8","first-page":"274","article-title":"Cardiopulmonary bypass time: Every minute counts","volume":"59","author":"Madhavan","year":"2017","journal-title":"J. Cardiovac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.bpa.2015.04.002","article-title":"Pulmonary complications of cardiopulmonary bypass","volume":"29","author":"Huffmyer","year":"2015","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/1749-8090-7-108","article-title":"Postoperative abdominal complications after cardiopulmonary bypass","volume":"7","author":"Dong","year":"2012","journal-title":"J. Cardiothor. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1093\/ejcts\/ezv356","article-title":"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)","volume":"49","author":"Conzelmann","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1093\/ejcts\/ezx302","article-title":"Medium-term survival after surgery for acute Type A aortic dissection is improving","volume":"52","author":"Olsson","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1080\/14017431.2016.1235284","article-title":"The Nordic Consortium for acute type A aortic dissection (NORCAAD): Objectives and design","volume":"50","author":"Geirsson","year":"2016","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lusa, L., and Ahlin, C. (2020). Resticted cubic splines for modelling periodic data. PLoS ONE, 28.","DOI":"10.1371\/journal.pone.0241364"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1111\/biom.12107","article-title":"Construction of confidence regions in the ROC space after the estimation of the optimal Youden Index-based cut-off point","volume":"70","author":"Bantis","year":"2014","journal-title":"Biometrics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2380","DOI":"10.1200\/JCO.2014.55.2208","article-title":"Moving beyond the hazard ratio in quantifying the between-group difference in survival analysis","volume":"32","author":"Uno","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1093\/biostatistics\/kxt050","article-title":"Predicting the restricted mean event time with the subject\u2019s baseline covariates in survival analysis","volume":"15","author":"Tian","year":"2014","journal-title":"Biostatistics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.12945\/j.aorta.2017.17.045","article-title":"Modifiable Risk Factors for Early Mortality in Low-Risk Penn Class Aa Acute Type A Aortic Dissection Patients\u2014A Descriptive Study","volume":"5","author":"Olsson","year":"2017","journal-title":"Aorta"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jtcvs.2017.08.137","article-title":"Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation","volume":"155","author":"Chiu","year":"2018","journal-title":"J. Thor. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1093\/ejcts\/ezs342","article-title":"Acute type A aortic dissection: Long-term results and reoperations","volume":"43","author":"Bekkers","year":"2013","journal-title":"Eur. J. Cardiothor. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.athoracsur.2011.10.059","article-title":"Reoperation after surgical correction of acute type A aortic dissection: Risk factor analysis","volume":"93","author":"Casali","year":"2012","journal-title":"Ann. Thor. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.jtcvs.2014.05.027","article-title":"Straight deep hypothermic circulatory arrest for cerebral protection during aortic arch surgery: Safe and effective","volume":"148","author":"Ziganshin","year":"2014","journal-title":"J. Thor. Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.athoracsur.2010.03.118","article-title":"Moderate hypothermia and unilateral selective antegrade cerebral perfusion: A contemporary cerebral protection strategy for aortic arch surgery","volume":"90","author":"Leshnower","year":"2010","journal-title":"Ann. Thor. Surg."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/4\/139\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:11:43Z","timestamp":1760029903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/4\/139"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,7]]},"references-count":23,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcdd12040139"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12040139","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,7]]}}}