Role of the surgical timing on postoperative outcomes after type A acute aortic dissection repair

Background Type A Aortic Dissection (TAAD) is a life-threatening disease that requires emergency surgical treatment. With a mortality rate reported as high as 2% per hour, the time to admission to hospital represent a crucial point in the management of these patients. This study aimed to assess how the time interval between onset of symptoms and hospital admission influences postoperative outcomes after TAAD repair. Methods From January 2011 to January 2020, 1406 consecutive patients underwent TAAD repair at our center. We included 1,228 patients who were admitted within 72 hours of symptom onset, and divided into two 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 = 0.06) and bradycardia on admission (11% vs 1.9%, p < 0.01) were more common in the early group. This group also had a higher incidence of preoperative limb ischemia (17% vs 11%, p < 0.01) and higher rates of rescue surgeries (16% vs 11%, p = 0.05). Despite prompt intervention, the postoperative mortality rate (15% vs 9.4%, p = 0.01), stroke rates (5.8% vs 2.8%, p = 0.03) and postoperative kidney failure (29% vs 21%, p < 0.01) were higher in the early group. Conclusions Our analysis indicates that the timing of surgery in TAAD patients 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.