Time is of the essence: where can we improve care in acute aortic dissection?

Author:

Saha Shekhar1ORCID,Fabry Thomas G1,Buech Joscha1,Ali Ahmad1,Joskowiak Dominik1ORCID,Tsilimparis Nikolaos2ORCID,Hagl Christian1,Pichlmaier Maximilian1ORCID,Peterss Sven1ORCID

Affiliation:

1. Department of Cardiac Surgery, LMU University Hospital, Munich, Germany

2. Division of Vascular Surgery, LMU University Hospital, Munich, Germany

Abstract

Abstract OBJECTIVES In acute aortic dissection type A various components of the diagnostic and logistic pathways may affect the time to definitive treatment. This study aimed to characterize these components and to identify factors delaying the optimal management within our institutional referral network. METHODS Between January 2017 and January 2020, 96 consecutive patients with classical aortic dissection type A were admitted (28%) or referred (72%) to our tertiary care centre and analysed retrospectively. Data are presented as medians (25th–75th quartile). RESULTS Median age was 66 years (56–74), 63% were male. Most of the patients were primarily admitted to a cardiology department (40%), whereas about a fourth were admitted to departments for internal medicine (26%) and general surgery (27%). The median interval from the onset of symptoms to hospital admission was 2.1 (1–4.4) h. From admission to confirmed diagnosis it took 2.1 (0.6–9.5) h and the median interval from confirmed diagnosis to admission at our specialized tertiary care aortic centre was 1.5 (0.9–2.4) h. Following admission to our centre, 1.1 (0.5–1.9) h passed until the induction of anaesthesia and 0.8 (0.0–1.1) h until the start of surgery. The total interval from the onset of symptoms to the start of surgery was 7.6 h (5.1–12.3). CONCLUSIONS The marked variability of the time from symptoms to diagnosis at any medical facility demonstrates the importance of awareness in the optimization of the treatment of acute aortic dissection type A.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,Surgery

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