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

Till Joscha Demal^{1

2}, Tim Knochenhauer¹, Jessica Weimann³, Tatu Juvonen^{4

5}, Timo Mäkikallio⁶, Antonio Fiore⁷, Andrea Perrotti⁸, Matteo Pettinari⁹, Sven Peterss¹⁰, Joscha Buech^{10

11}, Caroline Radner^{10

11}, Angelo M Dell'Aquila¹², Konrad Wisniewski¹³, Marek Pol¹⁴, Petr Kacer¹⁴, Francesco Onorati¹⁵, Alessandra Francica¹⁵, Igor Vendramin¹⁶, Daniela Piani¹⁶, Mauro Rinaldi¹⁷, Luisa Ferrante¹⁷, Eduard Quintana¹⁸, Robert Pruna-Guillen¹⁸, Javier Rodriguez Lega¹⁹, Angel G Pinto¹⁹, Metesh Acharya²⁰, Mark Field²⁰, Manoj Kuduvalli²⁰, Francesco Nappi²¹, Sebastien Gerelli²², Dario Di Perna²², Giuseppe Gatti²³, Enzo Mazzaro²³, Stefano Rosato²⁴, Paola D'Errigo²⁴, Giovanni Mariscalco²⁵, Zein El-Dean²⁵, Christian Detter¹, Hermann Reichenspurner^{1

2}, Gianluca Polvani^{26

27}, Fausto Biancari²⁶, Lenard Conradi²⁸

Affiliations

¹ Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
² German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
³ Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
⁴ Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
⁵ Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland.
⁶ Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
⁷ Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France.
⁸ Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France.
⁹ Department of Cardiac Surgery, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
¹⁰ Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany.
¹¹ German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
¹² Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
¹³ Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
¹⁴ Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
¹⁵ Division of Cardiac Surgery, University of Verona School of Medicine and Surgery, Verona, Italy.
¹⁶ Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
¹⁷ Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy.
¹⁸ Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
¹⁹ Cardiovascular Surgery Department, General University Hospital Gregorio Marañón, Madrid, Spain.
²⁰ Liverpool Center for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK.
²¹ Department of Cardiac Surgery, Center Cardiologique du Nord de Saint-Denis, Paris, France.
²² Department of Cardiac Surgery, Center Hospitalier Annecy Genevois, Epagny Metz-Tessy, France.
²³ Division of Cardiac Surgery, Cardiothoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
²⁴ National Center for Global Health, National Institute of Health, Rome, Italy.
²⁵ Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK.
²⁶ Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
²⁷ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
²⁸ Department of Cardiac Surgery, University Hospital Cologne, Cologne, Germany.

PMID: 40569847
DOI: 10.1093/ejcts/ezaf192

Observational Study

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

Till Joscha Demal et al. Eur J Cardiothorac Surg. 2025.

. 2025 Jun 3;67(6):ezaf192.

doi: 10.1093/ejcts/ezaf192.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
² German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
³ Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
⁴ Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
⁵ Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland.
⁶ Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
⁷ Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France.
⁸ Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France.
⁹ Department of Cardiac Surgery, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
¹⁰ Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany.
¹¹ German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
¹² Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
¹³ Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
¹⁴ Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
¹⁵ Division of Cardiac Surgery, University of Verona School of Medicine and Surgery, Verona, Italy.
¹⁶ Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
¹⁷ Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy.
¹⁸ Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
¹⁹ Cardiovascular Surgery Department, General University Hospital Gregorio Marañón, Madrid, Spain.
²⁰ Liverpool Center for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK.
²¹ Department of Cardiac Surgery, Center Cardiologique du Nord de Saint-Denis, Paris, France.
²² Department of Cardiac Surgery, Center Hospitalier Annecy Genevois, Epagny Metz-Tessy, France.
²³ Division of Cardiac Surgery, Cardiothoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
²⁴ National Center for Global Health, National Institute of Health, Rome, Italy.
²⁵ Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK.
²⁶ Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
²⁷ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
²⁸ Department of Cardiac Surgery, University Hospital Cologne, Cologne, Germany.

PMID: 40569847
DOI: 10.1093/ejcts/ezaf192

Abstract

Objectives: We aimed to investigate the differences in early and late outcomes after daytime compared to nighttime surgery for type A aortic dissection.

Methods: From 2005 to 2021, patients undergoing surgery for type A aortic dissection at 18 European centres participating in the European registry of type A aortic dissection were included in this study. Based on the time of procedure, patients were allocated into groups (8 a.m. to 8 p.m. vs 8 p.m. to 8 a.m.). After propensity-score matching, short- and long-term all-cause mortality and reoperation rate as well as secondary end-points including myocardial infarction, neurological outcome and renal failure were compared.

Results: A total of 3902 patients were included in this study. After propensity-score matching, outcomes of 1475 pairs of patients were compared. No differences were found regarding rates of surgical techniques. Daytime surgery was associated with an increased rate of global brain injury [daytime 5.4% (n = 80) vs nighttime 3.6% (n = 53); P = 0.021]. No significant differences were found in the rates of myocardial infarction, renal failure or neurological outcome other than global brain ischaemia. Significantly higher 1-year mortality (24.8% vs 21.7%, P = 0.049) and 10-year mortality (48.7% vs 45.1%, P = 0.022) was demonstrated in the daytime group. No significant differences in the rates of reoperation at 10 years were found.

Conclusions: This study demonstrates that surgery for type A aortic dissection performed during nighttime is not associated with adverse outcomes compared to daytime surgery, suggesting that nighttime procedures can be safely performed without compromising short- or long-term outcomes.

Clinical trial registration number: European Registry of Type A Aortic Dissection (ERTAAD) (Identifier: NCT04831073. URL: https://clinicaltrials.gov/study/NCT04831073).

Keywords: ERTAAD; Emergency surgery; GERAADA; Total arch replacement; Type A aortic dissection.

© The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Comment on "Outcome After Day- and Nighttime Surgery for Acute Type A Aortic Dissection".
Kambhampati B, Mehta R, Sah R. Kambhampati B, et al. Eur J Cardiothorac Surg. 2025 Sep 2;67(9):ezaf286. doi: 10.1093/ejcts/ezaf286. Eur J Cardiothorac Surg. 2025. PMID: 40857394 No abstract available.

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

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

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