Rapid Response in Type A Aortic Dissection: Is There a Decisive Time Interval for Surgical Repair?
Acute Disease
Aged
Aortic Dissection
/ diagnostic imaging
Aortic Aneurysm
/ diagnostic imaging
Clinical Decision-Making
Female
Humans
Male
Middle Aged
Postoperative Complications
/ etiology
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Time-to-Treatment
Treatment Outcome
Vascular Surgical Procedures
/ adverse effects
Journal
The Thoracic and cardiovascular surgeon
ISSN: 1439-1902
Titre abrégé: Thorac Cardiovasc Surg
Pays: Germany
ID NLM: 7903387
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
pubmed:
3
3
2020
medline:
30
4
2021
entrez:
2
3
2020
Statut:
ppublish
Résumé
The objective was to evaluate whether there is a decisive time interval for patients to undergo surgery and to analyze if a rapid response in acute aortic dissection type A (AADA) affects patient selection. In 283 patients undergoing surgery for AADA, median time from onset of initial symptoms to skin incision was 6.9 hours (interquartile range [IQR], 5.0-11.7 hours). Patients were divided into three groups according to median time point of surgery (median ± 3 hours, i.e., 4-10; < 4; and >10 hours). Almost 50% of patients presented in a critical preoperative state at hospital admission. Subanalysis identified patients being operated within 4 hours as an exclusive high-risk cohort (higher rates of preoperative neurologic dysfunction, tamponade, and cardiopulmonary resuscitation). Patients undergoing surgery between 4 and 10 hours showed a significantly better long-term survival ( Rapid response in AADA interacts with the natural course of the disease resulting in an overrepresentation of critical patients. While the cohort below 4 hours represents the high-risk patients, time from symptom onset to initiation of surgery should not exceed 10 hours.
Sections du résumé
BACKGROUND AND AIM OF THE STUDY
The objective was to evaluate whether there is a decisive time interval for patients to undergo surgery and to analyze if a rapid response in acute aortic dissection type A (AADA) affects patient selection.
METHODS
In 283 patients undergoing surgery for AADA, median time from onset of initial symptoms to skin incision was 6.9 hours (interquartile range [IQR], 5.0-11.7 hours). Patients were divided into three groups according to median time point of surgery (median ± 3 hours, i.e., 4-10; < 4; and >10 hours).
RESULTS
Almost 50% of patients presented in a critical preoperative state at hospital admission. Subanalysis identified patients being operated within 4 hours as an exclusive high-risk cohort (higher rates of preoperative neurologic dysfunction, tamponade, and cardiopulmonary resuscitation). Patients undergoing surgery between 4 and 10 hours showed a significantly better long-term survival (
CONCLUSION
Rapid response in AADA interacts with the natural course of the disease resulting in an overrepresentation of critical patients. While the cohort below 4 hours represents the high-risk patients, time from symptom onset to initiation of surgery should not exceed 10 hours.
Identifiants
pubmed: 32114688
doi: 10.1055/s-0039-1700967
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
49-56Informations de copyright
Thieme. All rights reserved.
Déclaration de conflit d'intérêts
None declared.