Abstract
Background This study explored if long-distance transfer was safe for patients suffering from
acute aortic dissection type A (AADA) and also analyzed the effectiveness of helicopter
transfer and cloud-type imaging transfer systems for such patients in northern Hokkaido,
Japan.
Methods and Results The study included 112 consecutive patients who underwent emergency surgical treatment
for AADA from April 2014 to September 2020. The patients were divided into two groups
according to the location of referral source hospitals: the Asahikawa city group (group
A, n = 49) and the out-of-the-city group (group O, n = 63). Use of helicopter transfer (n = 13) and cloud-type telemedicine (n = 20) in group O were reviewed as subanalyses.
Transfer distance differed between groups (4.2 ± 3.5 km in group A vs 107.3 ± 69.2 km
in group O; p = 0.0001), but 30-day mortality (10.2% in group A vs 7.9% in group O; p = 0.676) and hospital mortality (12.2% in group A vs 9.5% in group O; p = 0.687) did not differ. Operative outcomes did not differ with or without helicopter
and cloud-type telemedicine, but diagnosis-to-operation time was shorter with helicopter
(240.0 ± 70.8 vs 320.0 ± 78.5 minutes; p = 0.031) and telemedicine (242.0 ± 75.2 vs 319.0 ± 83.8 minutes; p = 0.007).
Conclusion We found that long-distance transfer did not impair surgical outcomes in AADA patients,
and both helicopter transfer and cloud-type telemedicine system could contribute to
the reduction of diagnosis-to-operation time in the large Hokkaido area. Further studies
are mandatory to investigate if both the systems will improve clinical outcomes.
Keywords
acute aortic dissection type A - long-distance transfer - helicopter - telemedicine
