{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T12:46:16Z","timestamp":1760013976538,"version":"3.44.0"},"reference-count":32,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"DOI":"10.13039\/501100002855","name":"Ministry of Science and Technology of the People's Republic of China","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002855","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["8180078"],"award-info":[{"award-number":["8180078"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82170503"],"award-info":[{"award-number":["82170503"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Health Commission of Hubei Province Scientific Research Project","award":["WJ2021Q005"],"award-info":[{"award-number":["WJ2021Q005"]}]},{"name":"Open Project of Jiangsu Province Health and Development Research Center","award":["JSHD2022042"],"award-info":[{"award-number":["JSHD2022042"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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.<\/jats:p><jats:p>A retrospective analysis of 288 ATAAD patients was conducted. Patients were separated into the early (\u226410\u2009h) and late (&gt;10\u2009h) groups by symptom-to-surgery time. Data on characteristics, surgery, and complications were compared, and multivariable logistic regression determined mortality risk factors.<\/jats:p><jats:p>Mortality rates did not significantly differ between early and late groups. Age (odds ratio [OR] 1.09, 95% CI 1.05\u20131.13, p\u2009&lt;\u20090.001), extracorporeal membrane oxygenation use (OR 10.73, 95% CI 2.51\u201345.87, p\u2009=\u20090.001), and malperfusion (OR 6.83, 95% CI 2.84\u201316.45, p\u2009&lt;\u20090.001) predicted operative death. Subgroup analysis showed cerebral (OR 3.20, 95% CI 1.11\u20139.26, p\u2009=\u20090.031), cardiac (OR 5.89, 95% CI 1.32\u201326.31, p\u2009=\u20090.020), and limb (OR 6.20, 95% CI 1.75\u201322.05, p\u2009=\u20090.005) malperfusion as predictors of operative death. One (OR 6.30, 95% CI 2.39\u201316.61, p\u2009&lt;\u20090.001), two (OR 12.79, 95% CI 2.74\u201359.81, p\u2009=\u20090.001), and three (OR 46.99, 95% CI 7.61\u2013288.94, p\u2009&lt;\u20090.001) organs malperfusion, together with Penn B (OR 7.96, 95% CI 3.04\u201320.81, p\u2009&lt;\u20090.001) and Penn B-C (OR 12.50, 95% CI 2.65\u201358.87, p\u2009=\u20090.001) classifications predict operative mortality. Survival analysis revealed significant differences between malperfusion and no malperfusion (34% vs. 9%, p\u2009&lt;\u20090.001) but not between late and early (14% vs. 21%, p\u2009=\u20090.132) groups. Malperfusion remained an essential predictor of operative (OR 7.06 95% CI 3.11\u201317.19, p\u2009&lt;\u20090.001) and midterm mortality (OR 3.38 95% CI 1.97\u20135.77, p\u2009&lt;\u20090.001) in subgroup analysis.<\/jats:p><jats:p>Preoperative malperfusion status, rather than symptom-to-surgery time, significantly impacts both operative and midterm mortality in ATAAD patients.<\/jats:p>","DOI":"10.1055\/a-2446-9886","type":"journal-article","created":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T19:23:43Z","timestamp":1729797823000},"page":"468-476","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Surgery Timing and Malperfusion on Acute Type A Aortic Dissection Outcomes"],"prefix":"10.1055","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0011-0846","authenticated-orcid":false,"given":"Xun E.","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenda","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanci","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing-Guo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,11,29]]},"reference":[{"issue":"10","key":"ref1","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1001\/jamacardio.2022.2718","article-title":"Early mortality in type A acute aortic dissection: insights from the International Registry of Acute Aortic 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