“Time is aorta?”: Timeliness of surgical repair in type A aortic dissection

Dimagli, Arnaldo; Angelini, Gianni

doi:10.1111/jocs.16412

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…Gasser and colleagues identified patients who underwent surgery within 4 h as an exclusive high-risk cohort with significantly higher rates of preoperative malperfusion [ 6 ]. This result might be due to the natural course of the disease resulting in an over-representation of critically ill and symptomatic patients with unstable ATAAD, leading to a significantly shorter onset-to-cut time [ 20 ]. Multiple factors might contribute to this scenario, including faster referral to a hospital after onset of symptoms and, in turn, a more rapid diagnosis, which makes inferences to the onset-to-cut time complex [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of onset-to-cut time in surgery for stable acute type A aortic dissection—a single-centre retrospective cohort study

Pitts,

Kofler,

Montagner

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES The study aim is to investigate the impact of onset-to-cut time on mortality in patients undergoing surgery for stable acute type A aortic dissection. METHODS Patients who underwent surgery for acute type A aortic dissection between 01/2006 and 12/2021 and available onset-to-cut times were included. Patients with unstable aortic dissection (preoperative shock, intubation, resuscitation, coma, pericardial tamponade and local/systemic malperfusion syndromes) were excluded. After descriptive analysis, a multivariable binary logistic regression for thirty-day mortality was performed. A receiver operating characteristic curve for onset-to-cut time and thirty-day mortality was calculated. Restricted cubic splines were designed to investigate the association between onset-to-cut time and survival. RESULTS The final cohort consisted of 362 patients. The median onset-to-cut time was 543 (376–1155) min. Thirty-day mortality was 9%. Only previous myocardial infarction (p = 0.018) and prolonged cardiopulmonary bypass time (p < 0.001) were identified as independent risk factors for thirty-day mortality. The corresponding area under the receiver operating characteristic curve showed a value of 0.49. Restricted cubic splines did not indicate an association between onset-to-cut time and survival (p = 0.316). CONCLUSIONS Onset-to-cut time in the setting of stable acute type A aortic dissection does not seem to be a valid predictor of thirty-day mortality in patients undergoing surgery and stayed stable during the preoperative course.

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Section: Discussionmentioning

confidence: 99%

The impact of onset-to-cut time in surgery for stable acute type A aortic dissection—a single-centre retrospective cohort study

Pitts,

Kofler,

Montagner

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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“…These results correlate with a high rate of persisting visceral malperfusion (A: 4.7%; B: 0%; P: 0.002) and persisting renal malperfusion (A: 8.1%; B: 1.4%; P: 0.001) after surgery. According to the IRAD, malperfusion is the second most important cause of death after aortic dissection ( 20 , 26 , 27 ). There are two possible explanations for this remaining malperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…First, progress of the aortic dissection membrane of the downstream aorta between the initial CT scan and start of surgery, and second, the progress of the aortic dissection intraoperatively induced. Crawford et al ( 27 ) previously described their observation that open aortic repair does not guarantee the restoration of distal perfusion as such, and end-organ malperfusion persists in up to 25% of patients, contributing to dismal operative outcomes ( 26 ). Nevertheless, only a minor number of malperfusions persist in patients with a longer time from pain onset to surgery.…”

Section: Discussionmentioning

confidence: 99%

Onset of pain to surgery time in acute aortic dissections type A: a mandatory factor for evaluating surgical results?

Kaufeld

Martens

Beckmann

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveAn acute aortic dissection type A (AADA) is a rare but life-threatening event. The mortality rate ranges between 18% to 28% and mortality is often within the first 24 h and up to 1%–2% per hour. Although the onset of pain to surgery time has not been a relevant factor in terms of research in the field of AADA, we hypothesize that a patient's preoperative conditions depend on the length of this time.MethodsBetween January 2000 and January 2018, 430 patients received surgical treatment for acute aortic dissection DeBakey type I at our tertiary referral hospital. In 11 patients, the exact time point of initial onset of pain was retrospectively not detectable. Accordingly, a total of 419 patients were included in the study. The cohort was categorized into two groups: Group A with an onset of pain to surgery time < 6 h (n = 211) and Group B > 6 h (n = 208), respectively.ResultsMedian age was 63.5 years (y) ((IQR: 53.3–71.4 y); (67.5% male)). Preoperative conditions differed significantly between the cohorts. Differences were detected in terms of malperfusion (A: 39.3%; B: 23.6%; P: 0.001), neurological symptoms (A: 24.2%; B: 15.4%; P: 0.024), and the dissection of supra-aortic arteries (A: 25.1%; B: 16.8%; P: 0.037). In particular, cerebral malperfusion (A 15.2%: B: 8.2%; P: 0.026) and limb malperfusion (A: 18%, B: 10.1%; P: 0.020) were significantly increased in Group A. Furthermore, Group A showed a decreased median survival time (A: 1,359.0 d; B: 2,247.5 d; P: 0.001), extended ventilation time (A: 53.0 h; B: 44.0 h; P: 0.249) and higher 30-day mortality rate (A: 25.1%; B: 17.3%; P: 0.051).ConclusionsPatients with a short onset of pain to surgery time in cases of AADA present themselves not only with more severe preoperative symptoms but are also the more compromised cohort. Despite early presentation and emergency aortic repair, these patients show increased chances of early mortality. The “onset of pain to surgery time” should become a mandatory factor when making comparable surgical evaluations in the field of AADA.

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