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. 2024 Jul 3;39(1):ivae130.
doi: 10.1093/icvts/ivae130.

The impact of onset-to-cut time in surgery for stable acute type A aortic dissection-a single-centre retrospective cohort study

Leonard Pitts  1   2 , Markus Kofler  1   2   3 , Matteo Montagner  1   2 , Roland Heck  1   2 , Stephan Dominik Kurz  1   2 , Alexandru Claudiu Paun  1   2 , Volkmar Falk  1   2   3   4 , Jörg Kempfert  1   2   3
Affiliations

The impact of onset-to-cut time in surgery for stable acute type A aortic dissection-a single-centre retrospective cohort study

Leonard Pitts et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: The goal of this study was to investigate the impact of onset-to-cut time on mortality in patients undergoing surgery for stable acute type A aortic dissection.

Methods: Patients who underwent surgery for acute type A aortic dissection between January 2006 and December 2021 and available onset-to-cut times were included. Patients with unstable aortic dissection (preoperative shock, intubation, resuscitation, coma, pericardial tamponade and local/systemic malperfusion syndromes) were excluded. After descriptive analysis, a multivariable binary logistic regression for 30-day mortality was performed. A receiver operating characteristic curve for onset-to-cut time and 30-day mortality was calculated. Restricted cubic splines were designed to investigate the association between onset-to-cut time and survival.

Results: The final cohort comprised 362 patients. The median onset-to-cut time was 543 (376-1155) min. The 30-day mortality was 9%. Only previous myocardial infarction (P = 0.018) and prolonged cardiopulmonary bypass time (P < 0.001) were identified as independent risk factors for 30-day mortality. The corresponding area under the receiver operating characteristic curve showed a value of 0.49. Restricted cubic splines did not indicate an association between onset-to-cut time and survival (P = 0.316).

Conclusions: Onset-to-cut time in the setting of stable acute type A aortic dissection does not seem to be a valid predictor of 30-day mortality in patients undergoing surgery and stayed stable during the preoperative course.

Keywords: Acute type A aortic dissection; Aorta; Malperfusion; Onset-to-cut time; Referral; Surgery.

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Figures

Figure 1:
Figure 1:
Flow chart for group formation and patient selection.
Figure 2:
Figure 2:
(A) Receiver operating curve for onset-to-cut time and 30-day mortality in stable acute type A aortic dissection. (B) Restricted cubic splines showing the relationship between onset-to-cut time and survival in stable acute type A aortic dissection. ATAAD: acute type A aortic dissection; CI: confidence interval.
Figure 3:
Figure 3:
Kaplan–Meier curve showing 1-year survival for patients undergoing surgery for stable acute type A aortic dissection. ATAAD: acute type A aortic dissection.
None
See this image and copyright information in PMC

References

    1. Pitts L, Montagner M, Kofler M, Van Praet KM, Heck R, Buz S et al. State of the art review: surgical treatment of acute type A aortic dissection. Surg Technol Int 2021;38:279–88. - PubMed
    1. Kurz SD, Falk V, Kempfert J, Gieb M, Ruschinski TM, Kukucka M et al. Insight into the incidence of acute aortic dissection in the German region of Berlin and Brandenburg. Int J Cardiol 2017;241:326–9. - PubMed
    1. Hirst AE Jr, Johns VJ Jr, Kime SW Jr. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958;37:217–79. - PubMed
    1. Montagner M, Kofler M, Seeber F, Pitts L, Starck C, Sundermann SH et al The arch remodelling stent for DeBakey I acute aortic dissection: experience with 100 implantations. Eur J Cardiothorac Surg 2022;62:ezac384. - PubMed
    1. Pitts L, Moon MC, Luehr M, Kofler M, Montagner M, Sündermann S et al. The Ascyrus medical dissection stent: a one-fits-all strategy for the treatment of acute type A aortic dissection? J Clin Med 2024;13:2593. - PMC - PubMed

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