# The impact of onset-to-cut time in surgery for stable acute type A aortic dissection—a single-centre retrospective cohort study

## TL;DR

This study examines whether the time from symptom onset to surgery affects 30-day mortality in patients with stable acute type A aortic dissection.

## Contribution

The study provides new evidence that onset-to-cut time is not a significant predictor of mortality in stable acute type A aortic dissection surgery.

## Key findings

- The median onset-to-cut time was 543 minutes with a 9% 30-day mortality rate.
- Previous myocardial infarction and prolonged cardiopulmonary bypass time were independent risk factors for mortality.
- Onset-to-cut time showed no significant association with survival.

## Abstract

The goal of this study was to investigate the impact of onset-to-cut time on mortality in patients undergoing surgery for stable acute type A aortic dissection.

Patients who underwent surgery for acute type A aortic dissection between January 2006 and December 2021 and available onset-to-cut times were included. Patients with unstable aortic dissection (preoperative shock, intubation, resuscitation, coma, pericardial tamponade and local/systemic malperfusion syndromes) were excluded. After descriptive analysis, a multivariable binary logistic regression for 30-day mortality was performed. A receiver operating characteristic curve for onset-to-cut time and 30-day mortality was calculated. Restricted cubic splines were designed to investigate the association between onset-to-cut time and survival.

The final cohort comprised 362 patients. The median onset-to-cut time was 543 (376–1155) min. The 30-day mortality was 9%. Only previous myocardial infarction (P = 0.018) and prolonged cardiopulmonary bypass time (P < 0.001) were identified as independent risk factors for 30-day mortality. The corresponding area under the receiver operating characteristic curve showed a value of 0.49. Restricted cubic splines did not indicate an association between onset-to-cut time and survival (P = 0.316).

Onset-to-cut time in the setting of stable acute type A aortic dissection does not seem to be a valid predictor of 30-day mortality in patients undergoing surgery and stayed stable during the preoperative course.

Acute type A aortic dissection (ATAAD) is associated with high morbidity and mortality [1, 2].