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Thorac Cardiovasc Surg 2021; 69(01): 049-056
DOI: 10.1055/s-0039-1700967
Original Cardiovascular

Rapid Response in Type A Aortic Dissection: Is There a Decisive Time Interval for Surgical Repair?

Simone Gasser 
1   Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
,
Lukas Stastny
1   Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
,
Markus Kofler
1   Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
2   Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Christoph Krapf
1   Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
,
Nikolaos Bonaros
1   Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
,
Michael Grimm
1   Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
,
Julia Dumfarth
1   Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
› Author Affiliations Funding The authors received no specific funding for this work.
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Abstract

Background and Aim of the Study The objective was to evaluate whether there is a decisive time interval for patients to undergo surgery and to analyze if a rapid response in acute aortic dissection type A (AADA) affects patient selection.

Methods In 283 patients undergoing surgery for AADA, median time from onset of initial symptoms to skin incision was 6.9 hours (interquartile range [IQR], 5.0–11.7 hours). Patients were divided into three groups according to median time point of surgery (median ± 3 hours, i.e., 4–10; < 4; and >10 hours).

Results Almost 50% of patients presented in a critical preoperative state at hospital admission. Subanalysis identified patients being operated within 4 hours as an exclusive high-risk cohort (higher rates of preoperative neurologic dysfunction, tamponade, and cardiopulmonary resuscitation). Patients undergoing surgery between 4 and 10 hours showed a significantly better long-term survival (p = 0.021). Surgery within this time interval had a clear protective effect on 30-day mortality (odds ratio [OR]: 0.448. 95% confidence interval [CI]: 0.219–0.915). High age (OR: 1.037; 95% CI: 1.008–1.067), preoperative malperfusion syndrome (OR: 2.802; 95% CI: 1.351–5.811), and preoperative tamponade (OR: 2.621; 95% CI: 1.171–5.866) were factors predicting 30-day mortality.

Conclusion Rapid response in AADA interacts with the natural course of the disease resulting in an overrepresentation of critical patients. While the cohort below 4 hours represents the high-risk patients, time from symptom onset to initiation of surgery should not exceed 10 hours.

Keywords

aorta/aortic - aortic valve - cardiac - outcomes - mortality - morbidity

Ethics

The article reports on retrospective research. All data analyzed were collected as part of routine diagnosis and treatment. No ethical considerations apply.


Authors' Contribution

Simone Gasser: concept/design, data analysis/interpretation, drafting article, statistics.


Lukas Stastny; Severin Semsroth; Christoph Krapf; Nikolaos Bonaros; and Thomas Schachner: critical revision of the article.


Markus Kofler: cirtical revision of the article, statistics.


Michael Grimm: concept/design, critical revision of article, approval of article.


Julia Dumfarth: concept/design, data acquisition, critical revision of the article, statistics, approval of the article.




Publication History

Received: 22 July 2019

Accepted: 03 December 2019

Article published online:
01 March 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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