Acute type A aortic dissection: timeline between onset and treatment

Abstract

Background: Patients with acute aortic dissection are affected with high early mortality. However, only limited data is available to delineate the factors that contribute to initial delays in establishing the diagnosis and treatment. Methods: In this single-centre, retrospective analysis, we reviewed 52 consecutive patients with acute type A aortic dissection (ATAAD) presenting at our institution (General Hospital Sint-Jan Bruges, Belgium) from January 2009 to October 2019. After thorough review of all medical records, a timeline was drawn for every patient, reflecting time delays from onset of symptoms to diagnosis and treatment. These data were supplemented with patients clinical characteristics. Statistical analysis using the Mann-Whitney U test (P<0.05) and the Kruskal-Wallis test (P<0.05) for independent samples were used. Results: The median time elapsed from ‘onset-to-presentation’ was 126.5 min (61–300 min), from ‘presentation-to-diagnosis’ 85.5 min (35.5–209 min), from ‘diagnosis-to-surgery’ 210 min (74–320.75 min) and from ‘onset-to-knife’ 600 min (337.5–1,125 min). The time from ‘diagnosis-to-surgery’ was significantly longer (P<0.05) than any of the other time-related variables. Gender, the mean amount of imaging studies needed to reach definitive diagnosis and the imaging study that provided definitive diagnosis had a significant influence on the ‘onset-to-knife’ time. Only the amount of imaging studies needed to reach definitive diagnosis was significantly related to the ‘presentation-to-diagnosis’ time. We report a 30-day mortality of 7.7% and an in-hospital mortality of 11.5%. Conclusions: Clinical knowledge and awareness remain very important to contribute to an early admission, followed by sharp and accurate diagnosis to improve outcome. Improvement in logistics should lead to shorter ‘diagnosis-to-surgery’ time. Owing to the time-dependent properties of ATAAD management, a (national) system of aortic dissection care should be drafted.