Diagnostic delay and outcome in surgery for type A aortic dissection

Twenty-two patients with acute type A aortic dissection presented to this hospital over a three-year period. The initial diagnosis was incorrect in 12 (54.5 per cent) and in 11 of these the error occurred in peripheral hospitals before referral. This diagnostic mistake lead to a delay in surgical treatment of 2-9 days (median 5 days). Three deaths occurred without surgery, and two of these could have been considered for repair if the correct diagnosis had been made earlier. In the surgically treated group, a 30-day survival of 16 out of 19 (84.2 per cent) was achieved and the three deaths were all related to late referral. Two died because of bowel infarction and one because of respiratory failure. An increased general awareness of acute aortic dissection is necessary as early diagnosis, before the onset of irreversible ischaemic events, allows a high surgical success rate.