Outcome after day- and nighttime surgery for acute type A aortic dissection.
作者信息
Demal Till Joscha, Knochenhauer Tim, Weimann Jessica, Juvonen Tatu, Mäkikallio Timo, Fiore Antonio, Perrotti Andrea, Pettinari Matteo, Peterss Sven, Buech Joscha, Radner Caroline, Dell'Aquila Angelo M, Wisniewski Konrad, Pol Marek, Kacer Petr, Onorati Francesco, Francica Alessandra, Vendramin Igor, Piani Daniela, Rinaldi Mauro, Ferrante Luisa, Quintana Eduard, Pruna-Guillen Robert, Lega Javier Rodriguez, Pinto Angel G, Acharya Metesh, Field Mark, Kuduvalli Manoj, Nappi Francesco, Gerelli Sebastien, Di Perna Dario, Gatti Giuseppe, Mazzaro Enzo, Rosato Stefano, D'Errigo Paola, Mariscalco Giovanni, El-Dean Zein, Detter Christian, Reichenspurner Hermann, Polvani Gianluca, Biancari Fausto, Conradi Lenard
机构信息
Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
出版信息
Eur J Cardiothorac Surg. 2025 Jun 3;67(6). doi: 10.1093/ejcts/ezaf192.
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).
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