Acute Type A Aortic Dissection Repair After Hours: Does It Influence Outcomes?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Diseases

Background:

• Time of day may influence surgical outcomes, but this is understudied for acute type A aortic dissection.
• Acute type A aortic dissection necessitates immediate surgical intervention.

Purpose of the Study:

• To investigate if the timing of acute type A aortic dissection repair (working hours vs. after hours) impacts patient outcomes.
• To compare perioperative data and short-term clinical outcomes between these two groups.

Main Methods:

• A review of 164 consecutive patients undergoing primary repair of acute type A dissection from July 2014 to October 2018.
• Patients were divided into 'working hours' (n=60) and 'after hours' (n=104) groups based on procedure start time.
• 58 pairs were propensity-matched for analysis of perioperative data and short-term outcomes.

Main Results:

• Thirty-day mortality was 10.4% overall and not significantly different between matched groups (13.8% working hours vs. 6.9% after hours; P=.36).
• Perfusion, cross-clamp, and circulatory arrest times were comparable between groups.
• Postoperative complications, including stroke, reoperation for bleeding, and renal failure, were also similar.

Conclusions:

• Thirty-day mortality and major morbidity following acute type A aortic dissection repair are not dependent on the time of surgery.
• Expeditious surgical intervention is recommended for all primary acute type A dissections, regardless of the time of day.