Cardiothoracic & vascular anesthesia
Is Prior Cardiac Surgery a Risk Factor for Patients in Aortic Surgery: A Systematic Review and Meta-analysis
Pooled result · In-hospital mortalityResult — go to the resultOdds ratio 0.55 95% CI 0.50–0.60Authors' 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.
Study context
- Population
- Patients undergoing aortic surgery, with vs without prior cardiac surgery
- Participants
- 31,631 patients · 19 studies
- Comparison
- Primary aortic surgery vs repeat sternotomy aortic surgery
- Outcome
- In-hospital mortality
Pooled result
As reported in the abstract
Odds ratio
0.55
95% CI 0.50–0.60
P < 0.001
By group
PAS vs RAS
OR 0.55 (95% CI 0.50–0.60); P < 0.001
Further pooled results
| Outcome | PAS | RAS | OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Re-exploration for bleeding | 7.2% | 9.4% | 0.76 (0.68–0.84) | P < 0.001 | |
| Renal failure | 13.3% | 15.8% | 0.73 (0.65–0.81) | P < 0.001 | |
| Short-term survival · 2 yearsShort-term survival favoured PAS | 62.6% | 55.2% | 0.74 (0.58–0.93) | P = 0.01 | |
| Long-term survival · 10 yearsLong-term survival converged between groups · particularly after propensity score matching | 14.8% | 12.7% | 0.82 (0.60–1.13) | P = 0.23 | |
| In-hospital mortality, aortic root surgery (subgroup) | 5.0% | 8.4% | 0.55 (0.50–0.61) | P < 0.001 | |
| In-hospital mortality, aortic arch surgery (subgroup)Benefit less pronounced than in root procedures | 8.4% | 11.9% | 0.60 (0.39–0.94) | P = 0.026 | |
| 0.20.5125Odds ratio (log scale) |
Safety
| Outcome | PAS | RAS | OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Re-exploration for bleeding | 7.2% | 9.4% | 0.76 (0.68–0.84) | P < 0.001 | |
| Renal failure | 13.3% | 15.8% | 0.73 (0.65–0.81) | P < 0.001 | |
| Deep sternal wound infection | 0.7% | 2.8% | 0.47 (0.37–0.60) | P < 0.001 | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Is Prior Cardiac Surgery a Risk Factor for Patients in Aortic Surgery: A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth. Published 2 July 2025. doi:10.
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