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

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], 5.0-11.7hours). Patients were divided into three groups according to median time point of surgery (median3hours, i.e., 4-10;<4; and >10hours). Results Almost 50% of patients presented in a critical preoperative state at hospital admission. Subanalysis identified patients being operated within 4hours as an exclusive high-risk cohort (higher rates of preoperative neurologic dysfunction, tamponade, and cardiopulmonary resuscitation). Patients undergoing surgery between 4 and 10hours 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 4hours represents the high-risk patients, time from symptom onset to initiation of surgery should not exceed 10hours.

Automated summary

The study aimed to evaluate the impact of time interval on surgery for acute aortic dissection type A (AADA) patients. Patients operated within 4-10 hours showed better long-term survival compared to those operated within 4 hours, who were at higher risk of preoperative neurologic dysfunction and cardiopulmonary resuscitation. It was concluded that time from symptom onset to surgery initiation should not exceed 10 hours.