Key result
Surgery for acute aortic dissection type A between 4 and 10 hours from symptom onset was associated with reduced 30-day mortality (OR 0.448; 95% CI 0.219-0.915) and better long-term survival.
Why the study?
It was unknown whether a decisive time interval exists for acute aortic dissection type A surgical repair and whether a rapid response affects patient selection.
Does the time interval from symptom onset to surgical repair affect mortality and survival in patients with acute aortic dissection type A?
Cohort (n=283)
Does the time interval from symptom onset to surgical repair affect mortality and survival in patients with acute aortic dissection type A?
Odds Ratio: 0.448 (95% CI 0.219–0.915)
In acute type A aortic dissection, surgical repair between 4 and 10 hours from symptom onset is associated with improved survival, as patients operated on in under 4 hours represent an inherently higher-risk cohort.
May support timing considerations in type A dissection; leaves open causality and practice change pending prospective data.
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.
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Gasser et al. (2020) conducted a cohort in Acute aortic dissection type A (AADA) (n=283). Surgery between 4 and 10 hours from symptom onset vs. Surgery <4 hours or >10 hours from symptom onset was evaluated on 30-day mortality (OR 0.448, 95% CI 0.219-0.915). Surgery for acute aortic dissection type A between 4 and 10 hours from symptom onset was associated with reduced 30-day mortality (OR 0.448; 95% CI 0.219-0.915) and better long-term survival.
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