Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: A total of 475 patients were included in the analysis. Prolonged CPB weaning time was significantly associated with increased postoperative in-hospital death (Odds Ratio[OR]: 1.05; 95% Confidence Interval[CI]: 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. CONCLUSIONS: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-026-05638-7.