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Thorac Cardiovasc Surg
DOI: 10.1055/a-2446-9886
Original Cardiovascular

Impact of Surgery Timing and Malperfusion on Acute Type A Aortic Dissection Outcomes

Xun E. Zhang 
1   Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
,
Wenda Yu
1   Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
,
Hanci Yang
1   Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
,
Chao Fu
1   Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
,
Bo Wang
1   Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
,
Lu Wang
1   Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
,
Qing-Guo Li
1   Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
› Author Affiliations Funding National Natural Science Foundation of China (NSFC) 8180078 and 82170503 to Z.X. and L.Q.G., respectively. Health Commission of Hubei Province Scientific Research Project WJ2021Q005 to W.B., and Open Project of Jiangsu Health Development Research Center JSHD2022042 to W.L.
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Abstract

Objective This study aimed to determine the impact of symptom-to-surgery time on mortality in acute type A aortic dissection (ATAAD) patients, with and without malperfusion.

Methods A retrospective analysis of 288 ATAAD patients was conducted. Patients were separated into the early (≤10 h) and late (>10 h) groups by symptom-to-surgery time. Data on characteristics, surgery, and complications were compared, and multivariable logistic regression determined mortality risk factors.

Results Mortality rates did not significantly differ between early and late groups. Age (odds ratio [OR] 1.09, 95% CI 1.05–1.13, p < 0.001), extracorporeal membrane oxygenation use (OR 10.73, 95% CI 2.51–45.87, p = 0.001), and malperfusion (OR 6.83, 95% CI 2.84–16.45, p < 0.001) predicted operative death. Subgroup analysis showed cerebral (OR 3.20, 95% CI 1.11–9.26, p = 0.031), cardiac (OR 5.89, 95% CI 1.32–26.31, p = 0.020), and limb (OR 6.20, 95% CI 1.75–22.05, p = 0.005) malperfusion as predictors of operative death. One (OR 6.30, 95% CI 2.39–16.61, p < 0.001), two (OR 12.79, 95% CI 2.74–59.81, p = 0.001), and three (OR 46.99, 95% CI 7.61–288.94, p < 0.001) organs malperfusion, together with Penn B (OR 7.96, 95% CI 3.04–20.81, p < 0.001) and Penn B-C (OR 12.50, 95% CI 2.65–58.87, p = 0.001) classifications predict operative mortality. Survival analysis revealed significant differences between malperfusion and no malperfusion (34% vs. 9%, p < 0.001) but not between late and early (14% vs. 21%, p = 0.132) groups. Malperfusion remained an essential predictor of operative (OR 7.06 95% CI 3.11–17.19, p < 0.001) and midterm mortality (OR 3.38 95% CI 1.97–5.77, p < 0.001) in subgroup analysis.

Conclusion Preoperative malperfusion status, rather than symptom-to-surgery time, significantly impacts both operative and midterm mortality in ATAAD patients.

Keywords

aorta/aortic - cardiac - outcomes (includes mortality - morbidity) - ischemia/reperfusion


Publication History

Received: 12 May 2024

Accepted: 16 October 2024

Accepted Manuscript online:
24 October 2024

Article published online:
29 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, Germany

 

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