Impact of downtime on surgical outcomes after repair of acute type A aortic dissection presenting with cardiopulmonary arrest

Objective: The management of acute type A aortic dissection with cardiopulmonary arrest remains controversial. We evaluated the impact of downtime on outcomes after aortic repair in this high-risk population. Methods: We retrospectively reviewed 711 patients with acute type A aortic dissection admitted between August 2003 and December 2024. Patients were categorized according to the presence of cardiopulmonary arrest and whether immediate aortic repair was performed. Among surgically treated patients with cardiopulmonary arrest, downtime was defined as the interval from collapse to return of spontaneous circulation or establishment of extracorporeal cardiopulmonary resuscitation. Early mortality, long-term survival, and discharge destination were analyzed. Downtime predicted discharge home with an area under the curve of 0.892, and the exploratory optimal cutoff was 18 minutes. Conclusions: Acute type A aortic dissection presenting with cardiopulmonary arrest carries exceptionally high risk. However, discharge home and long-term survival may be achieved in selected patients when downtime is short and immediate aortic repair follows successful resuscitation.