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

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Thoracic and Cardiovascular Surgeon Pub Date : 2024-10-24 DOI:10.1055/a-2446-9886

Xun Zhang, Wenda Yu, Hanci Yang, Chao Fu, Bo Wang, Lu Wang, Qingguo Li

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Abstract

Objective: 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 (OR 1.09, 95% CI 1.05-1.13, p<0.001), ECMO 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 mid-term mortality (OR 3.38 95% CI 1.97-5.77, p<0.001) in subgroup analysis.

Conclusions: Preoperative malperfusion status, rather than symptom-to-surgery time, significantly impacts both operative and mid-term mortality in ATAAD patients.

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手术时机和灌注不良对急性 A 型主动脉夹层预后的影响

目的：确定急性 A 型主动脉夹层（ATAAD）患者从症状到手术时间对死亡率的影响：确定急性 A 型主动脉夹层（ATAAD）患者从症状到手术的时间对死亡率的影响，包括有无灌注不良：对 288 名 ATAAD 患者进行了回顾性分析。方法：对288例ATAAD患者进行了回顾性分析，根据症状到手术时间将患者分为早期组（≤10小时）和晚期组（>10小时）。比较了特征、手术和并发症数据，并通过多变量逻辑回归确定了死亡风险因素：结果：早期组和晚期组的死亡率无明显差异。年龄（OR 1.09，95% CI 1.05-1.13，p结论：术前灌注不良状况，而非症状到手术的时间，对ATAAD患者的手术死亡率和中期死亡率都有显著影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thoracic and Cardiovascular Surgeon 医学-呼吸系统

CiteScore

3.40

自引率

6.70%

发文量

365

审稿时长

3 months

期刊介绍： The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.