PMID- 32114688
OWN - NLM
STAT- MEDLINE
DCOM- 20210429
LR  - 20221207
IS  - 1439-1902 (Electronic)
IS  - 0171-6425 (Linking)
VI  - 69
IP  - 1
DP  - 2021 Jan
TI  - Rapid Response in Type A Aortic Dissection: Is There a Decisive Time Interval for 
      Surgical Repair?
PG  - 49-56
LID - 10.1055/s-0039-1700967 [doi]
AB  - 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 
      (p = 0.021). Surgery within this time interval had a clear protective effect on 
      30-day mortality (odds ratio [OR]: 0.448. 95% confidence interval [CI]: 
      0.219-0.915). High age (OR: 1.037; 95% CI: 1.008-1.067), preoperative 
      malperfusion syndrome (OR: 2.802; 95% CI: 1.351-5.811), and preoperative 
      tamponade (OR: 2.621; 95% CI: 1.171-5.866) were factors predicting 30-day 
      mortality. 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.
CI  - Thieme. All rights reserved.
FAU - Gasser, Simone
AU  - Gasser S
AUID- ORCID: 0000-0003-0180-8338
AD  - Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical 
      University Innsbruck, Innsbruck, Austria.
FAU - Stastny, Lukas
AU  - Stastny L
AD  - Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical 
      University Innsbruck, Innsbruck, Austria.
FAU - Kofler, Markus
AU  - Kofler M
AD  - Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical 
      University Innsbruck, Innsbruck, Austria.
AD  - Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, 
      Berlin, Germany.
FAU - Krapf, Christoph
AU  - Krapf C
AD  - Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical 
      University Innsbruck, Innsbruck, Austria.
FAU - Bonaros, Nikolaos
AU  - Bonaros N
AD  - Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical 
      University Innsbruck, Innsbruck, Austria.
FAU - Grimm, Michael
AU  - Grimm M
AD  - Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical 
      University Innsbruck, Innsbruck, Austria.
FAU - Dumfarth, Julia
AU  - Dumfarth J
AD  - Department for Operative Medicine, University Clinic for Cardiac Surgery, Medical 
      University Innsbruck, Innsbruck, Austria.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20200301
PL  - Germany
TA  - Thorac Cardiovasc Surg
JT  - The Thoracic and cardiovascular surgeon
JID - 7903387
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Aortic Dissection/diagnostic imaging/mortality/*surgery
MH  - Aortic Aneurysm/diagnostic imaging/mortality/*surgery
MH  - Clinical Decision-Making
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/etiology
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - *Time-to-Treatment
MH  - Treatment Outcome
MH  - *Vascular Surgical Procedures/adverse effects/mortality
COIS- None declared.
EDAT- 2020/03/03 06:00
MHDA- 2021/04/30 06:00
CRDT- 2020/03/02 06:00
PHST- 2020/03/03 06:00 [pubmed]
PHST- 2021/04/30 06:00 [medline]
PHST- 2020/03/02 06:00 [entrez]
AID - 10.1055/s-0039-1700967 [doi]
PST - ppublish
SO  - Thorac Cardiovasc Surg. 2021 Jan;69(1):49-56. doi: 10.1055/s-0039-1700967. Epub 
      2020 Mar 1.