Preoperative Shock in Acute Type A Aortic Dissection: Multicenter Study of Mortality and Transport Time.

BACKGROUND: In acute type A aortic dissection (ATAAD), early surgical intervention is critical; however, prognostic determinants in geographically stable populations remain incompletely defined. We sought to identify key predictors of in-hospital mortality in a closed regional cohort. METHODS: We retrospectively analyzed patients undergoing surgery for ATAAD between January 2022 and June 2025 at 3 tertiary centers in Yamagata Prefecture, Japan. Demographics, transport time, admission to surgery interval, preoperative status, and operative variables were evaluated. Independent predictors of mortality were assessed by Cox proportional hazards modeling. RESULTS: Of 164 patients (mean age, 66.3 ± 11.9 years; 50% male), surgical mortality was 8.5% and in-hospital mortality was 10.4%. Nonsurvivors more frequently presented with preoperative shock (41% vs 12%; P < .001) and malperfusion (35% vs 15%; P = .05). In multivariable analysis, preoperative shock was the sole independent predictor of mortality (hazard ratio, 9.12; 95% CI, 2.88-28.8; P < .001), whereas transport time and operative complexity were not significant. CONCLUSIONS: In a geographically isolated, consistently managed cohort, preoperative shock was the dominant determinant of in-hospital mortality in ATAAD. These findings emphasize the importance of early recognition and stabilization before surgery rather than transport speed alone.