Diagnostic delay and outcome in surgery for type A aortic dissection.

Area of Science:

• Cardiology
• Thoracic Surgery
• Emergency Medicine

Background:

• Acute type A aortic dissection is a life-threatening cardiovascular emergency.
• Delayed diagnosis is a significant challenge, particularly in peripheral healthcare settings.
• Missed or delayed diagnoses can lead to prolonged intervals before surgical treatment.

Purpose of the Study:

• To evaluate the impact of diagnostic delays on patient outcomes in acute type A aortic dissection.
• To highlight the importance of early recognition and prompt surgical intervention.

Main Methods:

• Retrospective review of 22 patients with acute type A aortic dissection over a three-year period.
• Analysis of diagnostic accuracy, referral times, and treatment outcomes.

Main Results:

• Initial diagnosis was incorrect in 54.5% of patients, with most errors occurring before referral.
• Diagnostic delays ranged from 2-9 days (median 5 days), impacting surgical treatment.
• Three deaths occurred without surgery; two potentially treatable cases were missed due to delayed diagnosis.
• Surgically treated patients (n=19) had a 30-day survival rate of 84.2%.
• Late referral contributed to all three deaths in the surgical group (bowel infarction, respiratory failure).

Conclusions:

• Increased awareness of acute aortic dissection is essential for emergency physicians and referring clinicians.
• Early diagnosis is critical to prevent irreversible ischemic complications and improve surgical success rates.
• Prompt surgical intervention following accurate early diagnosis is associated with high survival rates.