Impact of Surgery Timing and Malperfusion on Acute Type A Aortic Dissection Outcomes

This study aimed to determine the impact of symptom-to-surgery time on mortality in acute type A aortic dissection (ATAAD) patients, with and without malperfusion. A retrospective analysis of 288 ATAAD patients was conducted. Patients were separated into the early (≤10 h) and late (>10 h) groups by symptom-to-surgery time. Data on characteristics, surgery, and complications were compared, and multivariable logistic regression determined mortality risk factors. Mortality rates did not significantly differ between early and late groups. Age (odds ratio [OR] 1.09, 95% CI 1.05–1.13, p < 0.001), extracorporeal membrane oxygenation use (OR 10.73, 95% CI 2.51–45.87, p = 0.001), and malperfusion (OR 6.83, 95% CI 2.84–16.45, p < 0.001) predicted operative death. Subgroup analysis showed cerebral (OR 3.20, 95% CI 1.11–9.26, p = 0.031), cardiac (OR 5.89, 95% CI 1.32–26.31, p = 0.020), and limb (OR 6.20, 95% CI 1.75–22.05, p = 0.005) malperfusion as predictors of operative death. One (OR 6.30, 95% CI 2.39–16.61, p < 0.001), two (OR 12.79, 95% CI 2.74–59.81, p = 0.001), and three (OR 46.99, 95% CI 7.61–288.94, p < 0.001) organs malperfusion, together with Penn B (OR 7.96, 95% CI 3.04–20.81, p < 0.001) and Penn B-C (OR 12.50, 95% CI 2.65–58.87, p = 0.001) classifications predict operative mortality. Survival analysis revealed significant differences between malperfusion and no malperfusion (34% vs. 9%, p < 0.001) but not between late and early (14% vs. 21%, p = 0.132) groups. Malperfusion remained an essential predictor of operative (OR 7.06 95% CI 3.11–17.19, p < 0.001) and midterm mortality (OR 3.38 95% CI 1.97–5.77, p < 0.001) in subgroup analysis. Preoperative malperfusion status, rather than symptom-to-surgery time, significantly impacts both operative and midterm mortality in ATAAD patients.