Outcome after day- and nighttime surgery for acute type A aortic dissection.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Management

Background:

• Type A aortic dissection is a life-threatening condition requiring prompt surgical intervention.
• The optimal timing for surgery (daytime vs. nighttime) for type A aortic dissection remains a subject of debate.
• The European Registry of Type A Aortic Dissection (ERTAAD) database provides a large cohort for comparative outcome analysis.

Purpose of the Study:

• To compare early and late outcomes of daytime versus nighttime surgery for type A aortic dissection.
• To assess the impact of surgical timing on mortality, reoperation rates, and secondary complications.
• To determine if nighttime surgery is associated with adverse outcomes in patients with type A aortic dissection.

Main Methods:

• Retrospective analysis of 3902 patients from 18 European centers (2005-2021) undergoing surgery for type A aortic dissection.
• Patients were categorized into daytime (8 a.m. to 8 p.m.) and nighttime (8 p.m. to 8 a.m.) surgical groups.
• Propensity-score matching was used to compare outcomes, including all-cause mortality, reoperation rates, myocardial infarction, neurological outcomes, and renal failure.

Main Results:

• After matching 1475 pairs, no differences in surgical techniques were observed.
• Daytime surgery was linked to a higher incidence of global brain injury (5.4% vs. 3.6%).
• Significantly higher 1-year (24.8% vs. 21.7%) and 10-year (48.7% vs. 45.1%) mortality rates were noted in the daytime group, with no difference in reoperation rates at 10 years.

Conclusions:

• Nighttime surgery for type A aortic dissection is not associated with adverse short- or long-term outcomes.
• The findings suggest that surgical timing does not compromise patient outcomes.
• Nighttime procedures for type A aortic dissection can be safely performed.