Rapid Response in Type A Aortic Dissection: Is There a Decisive Time Interval for Surgical Repair?Funding The authors received no specific funding for this work.
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.
The article reports on retrospective research. All data analyzed were collected as part of routine diagnosis and treatment. No ethical considerations apply.
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.
Received: 22 July 2019
Accepted: 03 December 2019
01 March 2020 (online)
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