JTCVS structural and endovascular · 2026
Impact of downtime on surgical outcomes after repair of acute type A aortic dissection presenting with cardiopulmonary arrest.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Izumi So, Miki Fuyuko, Kanno Reiko, Tsujimoto Takanori, Nakai Chikashi, Edono Kazumasa, Mizoue Ryouichi, Ijuin Shinichi, Ishihara Satoshi, Tsukube Takuro
Аннотация
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.
RESULTS: Among 222 patients with cardiopulmonary arrest, 30 underwent aortic repair and 192 did not. Aortic repair was performed in 489 patients without cardiopulmonary arrest. Early mortality was 100% in the cardiopulmonary arrest without surgery group, 40.0% in the patients with surgery group, and 5.1% in the noncardiopulmonary arrest group (P < .001). In the surgically treated cardiopulmonary arrest group, 6 patients were discharged home, and the 5-year survival rate was 30.5%. In the multivariable analysis, coronary malperfusion (P = .002) and longer downtime (P = .009) were associated with increased late mortality. 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.
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.
RESULTS: Among 222 patients with cardiopulmonary arrest, 30 underwent aortic repair and 192 did not. Aortic repair was performed in 489 patients without cardiopulmonary arrest. Early mortality was 100% in the cardiopulmonary arrest without surgery group, 40.0% in the patients with surgery group, and 5.1% in the noncardiopulmonary arrest group (P < .001). In the surgically treated cardiopulmonary arrest group, 6 patients were discharged home, and the 5-year survival rate was 30.5%. In the multivariable analysis, coronary malperfusion (P = .002) and longer downtime (P = .009) were associated with increased late mortality. 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.