Kaufeld Tim, Martens Andreas, Beckmann Erik, Rudolph Linda, Krüger Heike, Natanov Ruslan, Arar Morsi, Korte Wilhelm, Schilling Tobias, Haverich Axel, Shrestha Malakh
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States.
Front Cardiovasc Med. 2023 Apr 27;10:1102034. doi: 10.3389/fcvm.2023.1102034. eCollection 2023.
An acute aortic dissection type A (AADA) is a rare but life-threatening event. The mortality rate ranges between 18% to 28% and mortality is often within the first 24 h and up to 1%-2% per hour. Although the onset of pain to surgery time has not been a relevant factor in terms of research in the field of AADA, we hypothesize that a patient's preoperative conditions depend on the length of this time.
Between January 2000 and January 2018, 430 patients received surgical treatment for acute aortic dissection DeBakey type I at our tertiary referral hospital. In 11 patients, the exact time point of initial onset of pain was retrospectively not detectable. Accordingly, a total of 419 patients were included in the study. The cohort was categorized into two groups: Group A with an onset of pain to surgery time < 6 h ( = 211) and Group B > 6 h ( = 208), respectively.
Median age was 63.5 years (y) ((IQR: 53.3-71.4 y); (67.5% male)). Preoperative conditions differed significantly between the cohorts. Differences were detected in terms of malperfusion (A: 39.3%; B: 23.6%; P: 0.001), neurological symptoms (A: 24.2%; B: 15.4%; P: 0.024), and the dissection of supra-aortic arteries (A: 25.1%; B: 16.8%; P: 0.037). In particular, cerebral malperfusion (A 15.2%: B: 8.2%; P: 0.026) and limb malperfusion (A: 18%, B: 10.1%; P: 0.020) were significantly increased in Group A. Furthermore, Group A showed a decreased median survival time (A: 1,359.0 d; B: 2,247.5 d; P: 0.001), extended ventilation time (A: 53.0 h; B: 44.0 h; P: 0.249) and higher 30-day mortality rate (A: 25.1%; B: 17.3%; P: 0.051).
Patients with a short onset of pain to surgery time in cases of AADA present themselves not only with more severe preoperative symptoms but are also the more compromised cohort. Despite early presentation and emergency aortic repair, these patients show increased chances of early mortality. The "onset of pain to surgery time" should become a mandatory factor when making comparable surgical evaluations in the field of AADA.
急性A型主动脉夹层（AADA）是一种罕见但危及生命的疾病。死亡率在18%至28%之间，且死亡通常发生在最初24小时内，每小时高达1%-2%。尽管从疼痛发作到手术的时间在AADA领域的研究中并非一个相关因素，但我们推测患者的术前状况取决于这段时间的长短。
2000年1月至2018年1月期间，430例患者在我们的三级转诊医院接受了DeBakey I型急性主动脉夹层的手术治疗。11例患者回顾性分析无法确切检测到疼痛初始发作的时间点。因此，共有419例患者纳入研究。该队列分为两组：A组为疼痛发作到手术时间<6小时（n = 211），B组>6小时（n = 208）。
中位年龄为63.5岁（四分位间距：53.3-71.4岁）；男性占67.5%。两组患者术前状况差异显著。在灌注不良（A组：39.3%；B组：23.6%；P：0.001）、神经症状（A组：24.2%；B组：15.4%；P：0.024）和主动脉弓上动脉夹层（A组：25.1%；B组：16.8%；P：0.037）方面存在差异。特别是，A组脑灌注不良（A组15.2%：B组：8.2%；P：0.026）和肢体灌注不良（A组：18%，B组：10.1%；P：0.020）显著增加。此外，A组中位生存时间缩短（A组：1359.0天；B组：2247.5天；P：0.001），通气时间延长（A组：53.0小时；B组：44.0小时；P：0.249），30天死亡率更高（A组：25.1%；B组：17.3%；P：0.051）。
AADA患者从疼痛发作到手术时间短，不仅术前症状更严重，而且是更易受影响的队列。尽管早期就诊并进行了急诊主动脉修复，但这些患者早期死亡的几率增加。在AADA领域进行可比的手术评估时，“疼痛发作到手术时间”应成为一个必需的因素。
