Annals of thoracic surgery short reports · 2025
Outcome of Transfer Time Difference From Diagnosis to Operation Room in Acute Type A Aortic Dissection Complicated by Malperfusion.
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Nakai Chikashi, Ku Andrew, Wu Yuan Haw, Liu Junyi, Azhagiri Nikhil, Danduch Eduardo, Tarabichi Saeed, Zhang Li, Samy Sanjay
Аннотация
BACKGROUND: There are few reports of time effect for postoperative outcomes in patients with acute type A aortic dissection (ATAAD) complicated by malperfusion syndrome (MPS), especially transfer time difference from diagnosis to operation room (OR). To elucidate whether time between diagnosis and OR might be a significant factor, this study evaluated surgical outcomes of ATAAD complicated by MPS.
METHODS: Between October 2013 and June 2024, 159 patients with ATAAD underwent emergent aortic repair; 54.7% (87/159) presented with MPS, 45.3% (72/159) without MPS. Of 87 patients with MPS, 69.0% (60/87) were transferred to the OR within 150 minutes from initial diagnosis (immediate repair), whereas 31.0% (27/87) were transferred to the OR after 150 minutes (late repair).
RESULTS: In the MPS group, there was a significant difference in 30-day mortality rate between immediate and late repair, 20.0% (12/60) vs 48.1% (13/27; P < .01). Mean follow-up time was 33.0 ± 35.8 months. Cumulative survival rate in 5 years of patients with MPS was 64.6% for immediate repair and 46.1% for late repair. A significant difference was noted in long-term outcome between the groups (P = .03), whereas there was no difference in the non-MPS group (P = .11). On multivariable Cox regression analysis, age >65 years, cardiac tamponade, and late aortic repair were associated with increased long-term mortality (P = .02, .02, and <.01).
CONCLUSIONS: Immediate transfer from diagnosis to OR significantly improved long-term outcome in patients with ATAAD complicated by MPS. Older age and preoperative cardiac tamponade worsened long-term mortality in this cohort.
METHODS: Between October 2013 and June 2024, 159 patients with ATAAD underwent emergent aortic repair; 54.7% (87/159) presented with MPS, 45.3% (72/159) without MPS. Of 87 patients with MPS, 69.0% (60/87) were transferred to the OR within 150 minutes from initial diagnosis (immediate repair), whereas 31.0% (27/87) were transferred to the OR after 150 minutes (late repair).
RESULTS: In the MPS group, there was a significant difference in 30-day mortality rate between immediate and late repair, 20.0% (12/60) vs 48.1% (13/27; P < .01). Mean follow-up time was 33.0 ± 35.8 months. Cumulative survival rate in 5 years of patients with MPS was 64.6% for immediate repair and 46.1% for late repair. A significant difference was noted in long-term outcome between the groups (P = .03), whereas there was no difference in the non-MPS group (P = .11). On multivariable Cox regression analysis, age >65 years, cardiac tamponade, and late aortic repair were associated with increased long-term mortality (P = .02, .02, and <.01).
CONCLUSIONS: Immediate transfer from diagnosis to OR significantly improved long-term outcome in patients with ATAAD complicated by MPS. Older age and preoperative cardiac tamponade worsened long-term mortality in this cohort.