Objective: This study aimed to determine the impact of symptom-to-surgery time on mortality in acute type A aortic dissection (ATAAD) patients, with and without malperfusion.
Methods: A retrospective analysis of 288 ATAAD patients was conducted. Patients were separated into the early (≤10 h) and late (>10 h) groups by symptom-to-surgery time. Data on characteristics, surgery, and complications were compared, and multivariable logistic regression determined mortality risk factors.
Results: Mortality rates did not significantly differ between early and late groups. Age (odds ratio [OR] 1.09, 95% CI 1.05-1.13, p < 0.001), extracorporeal membrane oxygenation use (OR 10.73, 95% CI 2.51-45.87, p = 0.001), and malperfusion (OR 6.83, 95% CI 2.84-16.45, p < 0.001) predicted operative death. Subgroup analysis showed cerebral (OR 3.20, 95% CI 1.11-9.26, p = 0.031), cardiac (OR 5.89, 95% CI 1.32-26.31, p = 0.020), and limb (OR 6.20, 95% CI 1.75-22.05, p = 0.005) malperfusion as predictors of operative death. One (OR 6.30, 95% CI 2.39-16.61, p < 0.001), two (OR 12.79, 95% CI 2.74-59.81, p = 0.001), and three (OR 46.99, 95% CI 7.61-288.94, p < 0.001) organs malperfusion, together with Penn B (OR 7.96, 95% CI 3.04-20.81, p < 0.001) and Penn B-C (OR 12.50, 95% CI 2.65-58.87, p = 0.001) classifications predict operative mortality. Survival analysis revealed significant differences between malperfusion and no malperfusion (34% vs. 9%, p < 0.001) but not between late and early (14% vs. 21%, p = 0.132) groups. Malperfusion remained an essential predictor of operative (OR 7.06 95% CI 3.11-17.19, p < 0.001) and midterm mortality (OR 3.38 95% CI 1.97-5.77, p < 0.001) in subgroup analysis.
Conclusion: Preoperative malperfusion status, rather than symptom-to-surgery time, significantly impacts both operative and midterm mortality in ATAAD patients.
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