Comparison of prognoses of patients with type A aortic dissection treated with surgery in acute, subacute and chronic phases.

BACKGROUND: Prior research has indicated that patients with chronic type A aortic dissection (CTAAD) tend to have better postoperative outcomes compared to those with acute type A aortic dissection (ATAAD). Nevertheless, the comparative prognosis between patients undergoing surgery for subacute type A aortic dissection (STAAD) and CTAAD has not yet been clearly established. The primary objective of this study is to compare the clinical outcomes of patients with aortic dissection who undergo surgical repair at different time periods following the onset of the condition, thereby providing relevant evidence for clinical practice.

METHODS: This study included a total of 834 patients with type A aortic dissection, comprising 618 acute cases, 145 subacute cases, and 71 chronic cases. We retrospectively collected their clinical data and conducted statistical analysis. Initially (analysis 1), based on whether the time from onset was less than 14 days, we divided all patients into two groups: the acute group and the non-acute group, to evaluate the differences in clinical outcomes between the two groups. Subsequently (analysis 2), for the non-acute group, we further categorized them into the subacute group and the chronic group based on whether the time from onset was less than 90 days, and again assessed the differences in clinical outcomes between these two groups. To ensure comparability between the groups, we used propensity score matching (PSM) to balance baseline differences.

RESULTS: In analysis 1, after PSM, a total of 215 matched pairs of patients were obtained, with comparable baseline characteristics between the two groups. Compared to acute-phase surgery, patients undergoing non-acute-phase surgery had shorter intraoperative cardiopulmonary bypass (CPB) time and aortic cross-clamp time. Additionally, the incidence of postoperative neurological complications (P=0.006), cardiovascular complications (P=0.007), incision-related complications (P=0.03), and postoperative dialysis (P<0.001) was significantly lower in the non-acute group. In analysis 2, after PSM, a total of 71 matched pairs of patients were obtained, with comparable baseline characteristics between the two groups. The comparison results showed no significant differences in the incidence of major postoperative complications or 30-day mortality between the two groups. Furthermore, multivariate Cox Proportional Hazards Model (Cox) regression analysis revealed that, compared to acute-phase surgery, non-acute-phase surgery was associated with lower 30-day mortality; however, there was no statistically significant difference between subacute-phase and chronic-phase surgery.

CONCLUSIONS: Compared to surgery during the acute phase of aortic dissection, procedures performed during the subacute and chronic phases can reduce the incidence of complications and mortality in patients, but there is no difference between the subacute and chronic phases. In clinical practice, for non-acute phase patients, surgery should also be performed as soon as possible, rather than opting for a wait-and-see approach or choosing elective surgery.