Association between surgical timing and postoperative outcomes in type A acute aortic dissection.

OBJECTIVE: This study aimed to assess how the time interval between onset of symptoms and hospital admission associates with postoperative outcomes after type A acute aortic dissection (TAAD) repair. METHODS: From January 2011 to January 2020, 1406 consecutive patients underwent TAAD repair at our center. We included 1228 patients who were admitted within 72 hours of symptom onset and divided them into 2 groups: 867 patients in the early (≤12 hours) and 361 in the late (>12 hours and <72 hours) admission group. RESULTS: Hypotension (11% vs 7.6%, P = .06) and bradycardia on admission (11% vs 1.9%, P < .01) were more common in the early group. This group also had a greater incidence of preoperative limb ischemia (17% vs 11%, P < .01) and greater rates of rescue surgeries (16% vs 11%, P = .05). Despite prompt intervention, the postoperative mortality rate (15% vs 9.4%, P = .01), stroke rates (5.8% vs 2.8%, P = .03), and postoperative kidney failure (29% vs 21%, P < .01) were greater in the early group. CONCLUSIONS: Our analysis indicates that the timing of surgery in patients with TAAD is primarily driven by the presence of more severe symptoms and signs of ischemia and, despite early treatment, these patients have increased rates of complications and mortality. This emphasizes the importance of the clinical status on admission, rather than the time, as the main driver for postoperative complications.