TITLE:
Intraoperative Parameters and Postoperative Outcomes in Ascending Aortic Surgery: A Comparative Study of Elective and Emergency Interventions
AUTHORS:
Mustafa Tabakovic, Rusmir Softic, Mithat Tabakovic
KEYWORDS:
Ascending Aortic Aneurysm, Type A Aortic Dissection, Cardiopulmonary Bypass, Hypothermic Circulatory Arrest, Postoperative Complications, Emergency Surgery
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.17 No.4,
April
7,
2026
ABSTRACT: 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 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 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.