Risk factors for and outcomes of prolonged mechanical ventilation in patients received DeBakey type I aortic dissection repairment

BackgroundThis study aimed to identify risk factors for prolonged mechanical ventilation (PMV) and its association with disease prognosis following acute DeBakey type I aortic dissection surgery.MethodsA total of 582 patients who received emergency surgery for acute DeBakey type I aortic dissection from 2014 to 2018 were enrolled in this study. Mechanical ventilation period after surgery longer than 48 hours was defined as postoperative PMV. Multiple logistic regression analysis was used to identify risk factors for PMV. This study also compared short- and long-term outcomes in patients who developed PMV with patients who did not develop this complication. To identify and compare long-term cumulative survival rate, Kaplan-Meier survival curve was plotted.ResultsAmong all enrolled patients, 259 (44.5%) received PMV treatment. Our data suggested that the length of intensive care unit and hospital stay were longer for patients who received PMV treatment. Thirty-day mortality was also higher in patients with PMV than in patients without PMV. Elevated leukocyte count and increased serum cystatin C level upon admission, lower preoperative platelet count and longer cardiopulmonary bypass (CPB) duration were identified as risk factors for PMV. Interestingly, our data suggested that there was no significant difference of survival rate between patients with or without PMV history.ConclusionsPMV after DeBakey type I aortic dissection repair surgery was a common complication and associated with increased short-term mortality rate but did not affect long-term mortality rate. Elevated preoperative leukocyte count, increased preoperative serum cystatin C level, lower preoperative platelet count and longer CPB duration were risk factors for PMV.     

瓣膜置换术后机械通气时间延长的危险因素分析

目的 分析瓣膜置换术后机械通气时间延长(≥48 h)的危险因素.方法 回顾我院2010年1月～2011年8月行心脏瓣膜置换术的518例患者的临床资料,并对术后机械通气辅助呼吸时间延长(≥48 h)的危险因素进行分析.结果 手术后机械通气时间超过48 h的患者72例,发生率13.9％.单因素分析结果表明,患者的年龄、心功能分级、术前血浆BNP水平、射血分数、肺动脉收缩压、同期行冠状动脉旁路移植手术、主动脉内球囊反搏支持、体外循环时间、主动脉阻断时间、置换瓣膜的数量、术后使用多巴胺≥10 μg/( kg·min)以及术后使用肾上腺素与患者术后机械通气时间延长相关(P＜0.05或P＜0.01),上述因素进入二元逐步Logistic回归分析,结果显示患者的心功能分级、肺动脉收缩压和术后使用多巴胺≥10μg/(kg·min)与术后机械通气时间延长独立相关(P＜0.05或P＜0.01).结论 瓣膜置换术后机械通气时间延长的影响因素较多,其中患者的心功能分级、肺动脉收缩压和术后使用多巴胺≥10μg/(kg·min)是患者术后机械通气时间延长的独立危险因素.     

DebakeyⅠ型主动脉夹层术后急性呼吸功能不全的危险因素

目的 分析DebakeyⅠ型主动脉夹层术后急性呼吸功能不全（acute respiratory insufficiency,ARI)的相关因素。方法39例DebakeyⅠ主动脉夹层患者在深低温停循环下行手术治疗。收集患者术前、术中可疑变量进行统计分析〔(年龄、性别、高血压病、吸烟史、体质量指数(BMI)、术前氧合指数、灌注不良综合征、发病至手术时间、术后24 h内输注红细胞及血浆量、胸膜破裂、术后24 h胸管引流量、体外循环(cardiopulmonary bypass,CPB)时间、深低温停循环(deep hypothermic circulatory arrest,DHCA)时间、主动脉阻断时间〕。先对上述变量进行单因素分析,再将单因素分析中有统计学意义的变量,代入Logistic回归模型中进行多因素分析。结果 入选呼吸功能不全患者30例,无呼吸功能不全患者9例。单因素分析结果显示吸烟史、BMI>25 kg/m2、术前氧合指数<300、手术距发病时间<2周、灌注不良综合征、CPB时间>160 min、术后24 h红细胞输入量>10 U、术后24 h血浆输入量>1 000 ml有统计学意义（P<0.05）。多因素Logistic 回归分析的结果显示,以下因素为术后发生ARI的独立危险因素:BMI>25 kg/m2（P<0.01）;术前氧合指数<300（P<0.05）;术前灌注不良综合征（P<0.01）;术后24 h血浆输入量>1 000 ml（P<0.05）;CPB时间>160 min（P<0.01）。结论 DebakeyⅠ主动脉夹层患者深低温停循环术后发生ARI的危险因素包括:BMI>25 kg/m2;术前氧合指数<300;术前灌注不良综合征;术后24 h血浆输入量>1 000 ml;CPB时间>160 min。     

Risk factors analysis for in-hospital death of acute Stanford type B aortic dissection

Background Data is limited regarding the correlation between related factors and in-hospital death of Stanford type B acute aortic dissection (AAD). Methods We registered consecutive Stanford type B AAD patients, who were in the Guangdong Cardiovascular Institute of Guangdong General Hospital from October 2010 to August 2011, and the onset day to admission day were less than or equal to 2 weeks. We collected in-hospital mortality, history of disease, laboratory parameters, some biochemical markers tests, treatment and so on, analyzed the relationship between risk factors and mortality. Results One hundred and five Stanford B AAD patients were enrolled, 9 patients died, accounting for 8.6%. There are 24 patients treated with medicine, and 4 cases finally died. Endovascular aortic repair (EVAR) 62 cases, 2 cases died. EVAR combined carotid artery bypass (CAB) 19 cases, and 3 cases died. Among the three treatments, there was no significant difference in statistics (P = 0.063). Compared with the survivors, the death group had higher D-dimer (P = 0.016) and NT-proBNP (P = 0.014) level, and more patients with myocardial infarction (P = 0.007), hypotension or shock (P = 0.019), a- cute renal failure (P = 0.005), nervous system related events (P 0.001). After adjusting for other predictors of in-hospital death, logistic regression analysis shows that the nervous system related events (odds ratio: 21.648; 95% CI: 1.228-381.704, P = 0.036 is the independent risk factor for death. Conclusions D-dimer, hypotension or shock, acute renal failure, nervous system related events are associated with hospitalization death of Stanford type B AAD patients, while nervous system related events is an independent risk factor for in-hospital death.     

Risk factors for diagnostic delay in acute aortic dissection

In acute aortic dissection (AAD), timely diagnosis is challenging. However, dedicated studies of the entity and determinants of delay are currently lacking. We surveyed pre-/in-hospital time to diagnosis and explored risk factors for diagnostic delay. We analyzed the dedicated database of a metropolitan AAD network (161 patients diagnosed since 1996; 115 Stanford type A) in terms of hospital arrival times (from pain to presentation at any hospital) and in-hospital diagnostic times (presentation to final diagnosis). Median (interquartile range) in-hospital diagnostic times were approximately twofold greater than hospital arrival times (177 minutes, 644, vs 75 minutes, 124, p = 0.0001, Wilcoxon test). Median annual in-hospital diagnostic times were most often approximately 3 hours (spread was wide, but decreased after 2001; rho = -0.94, p = 0.005). Risk factors (univariate analysis) for in-hospital diagnostic time >75th percentile (12 hours) included pleural effusion (odds ratio 3.96, 95% confidence interval 1.80 to 8.69), dyspneic presentation (odds ratio 3.33, 95% confidence interval 1.93 to 8.59), and age <70 years (odds ratio 2.34, 95% confidence interval 1.03 to 5.36). Systolic arterial pressure < or =105 mm Hg decreased the likelihood of lengthy diagnosis (odds ratio 0.08, 95% confidence interval 0.01 to 0.59). In patients (n = 82) with routine values (since 2000), troponin positivity (odds ratio 3.63, 95% confidence interval 1.12 to 11.84) and an acute coronary syndrome-like electrocardiogram (odds ratio 2.88, 95% confidence interval 1.01 to 8.17) were also risk factors. In conclusion, in a metropolitan setting, most of the diagnostic delay may occur in hospital. At presentation, pleural effusion, troponin positivity, acute coronary syndrome-like electrocardiogram, and dyspnea are possible "clinical confounders" associated with particularly long in-hospital diagnostic times.     

吸入一氧化氮治疗急性A型主动脉夹层术后严重低氧血症

目的 研究临床应用吸入一氧化氮（iNO）治疗急性A型主动脉夹层（acute type A aortic dissection, ATAAD)手术后严重低氧血症的疗效。方法 回顾性分析2015年1月至2020年12月我院手术的ATAAD患者资料,排除术后72小时内死亡和术后脑中风、截瘫患者,共48例严重低氧血症（氧合指数低于100mmHg）患者入组。2018年9月之前采用常规疗法,共28例,归入CON组;2018年10月之后应用iNO治疗患者共20例,归入iNO组,除了常规方法外给予吸入5ppm浓度NO。结果 两组术前资料差异无统计学意义。术中手术方式、时间、输血量等无统计学差异。术后常规疗法低氧血症改善缓慢,应用iNO治疗氧合指数上升明显加快。术后早期病死率iNO组（10%）与CON组（10.7%）相比无统计差异。iNO组机械通气时间（87.3±13.1 h）低于CON组（128.5±16.6 h）,ICU停留时间iNO组（12.1±1.57 d）低于CON组（14.4±1.93 d）,术后住院时间iNO组（19.8±1.64 d）短于CON组（21.4±1.93 d）。结论 iNO治疗ATAAD术后严重低氧血症安全有效,可显著促进氧合功能改善、减少气管插管呼吸机使用时间。     

Long-term results of surgery for type A acute aortic dissection

The cases of 160 patients (126 men, mean age 57.5 +/- 13.3 years) operated consecutively as an emergency for a Stanford type A dissection of the aorta between 1980 and 2000 were reviewed. The cumulative follow-up was 716.7 patient-years with an average follow-up of 4.51 +/- 5.6 patient-years. The risk factors for early postoperative mortality (up to 3 months), late mortality (> 3 months) and reoperation (cardiac and/or vascular) were determined by multivariate analysis. The hospital mortality was 27.5%. Older ages, obesity, previous cardiac surgery, preoperative shock, medullary, renal or mesenteric ischaemia were significant risk factors for early mortality. The probability of actuarial survival was 66.1 +/- 3.8%, 57.7 +/- 4.2%, 52.2 +/- 4.6% and 45.3 +/- 5.5% respectively at 1, 5, 10 and 15 years. Chronic obstructive airways disease and a more recent operation date were significant risk factors for late mortality. Thirty patients underwent 37 reoperations after an average of 5.7 +/- 4.5 years. The actuarial probability for no reoperation was 96.9 +/- 1.8%, 74.7 +/- 5.3%, 60.8 +/- 6.8% and 39.3 +/- 9.1% at 1, 5, 10 and 15 years respectively. The presence of severe preoperative aortic regurgitation was the only significant risk factor for reoperation. Type A acute dissection of the aorta continues to have a high early mortality and a significant incidence of late complications. Patients with severe aortic regurgitation before surgery are at high risk for reoperation and should probably have more radical aortic repair at the initial operation.     

Risk factors for acute kidney injury in overweight patients with acute type A aortic dissection: a retrospective study

Background

To identify risk factors for acute kidney injury (AKI) in overweight patients who underwent surgery for acute type A aortic dissection (TAAD).

Methods

A retrospective study including 108 consecutive overweight patients [body mass index (BMI) ≥24] between December 2009 and April 2013 in Beijing Anzhen Hospital has been performed. AKI was defined by Acute Kidney Injury Network (AKIN) criteria, which is based on serum creatinine (sCr) or urine output.

Results

The mean age of the patients was 43.69±9.66 years. Seventy-two patients (66.7%) developed AKI during the postoperative period. A logistic regression analysis was performed to identify two independent risk factors for AKI: elevated preoperative sCr level and 72-h drainage volume. Renal replacement therapy (RRT) was required in 15 patients (13.9%). The overall postoperative mortality rate was 7.4%, 8.3% in AKI group and 5.6% in non-AKI group. There is no statistically significant difference between the two groups (P=0.32).

Conclusions

A higher incidence of AKI (66.7%) in overweight patients with acute TAAD was confirmed. The logistic regression model identified elevated preoperative sCr level and 72-h drainage volume as independent risk factors for AKI in overweight patients. We should pay more attention to prevent AKI in overweight patients with TAAD.     

Factors associated with prolonged mechanical ventilation following coronary artery bypass surgery

STUDY OBJECTIVES: To identify the typical duration of postoperative mechanical ventilation following coronary artery bypass graft surgery (CABG), and to identify risk factors for prolonged postoperative ventilation. DESIGN: Retrospective study of 4,863 consecutive patients using univariate and multivariate survival analysis to identify independent risk factors. SETTING: Saint Thomas Hospital, Nashville, TN, a 575-bed, academically affiliated, regional referral hospital specializing in cardiovascular diseases. PATIENTS: All patients undergoing CABG in our hospital from January 1, 1996, to December 31, 1997. INTERVENTIONS: None. Measurements and results: Duration of mechanical ventilation and mortality were measured. More than 94% of the patients were extubated in the first 3 days following surgery, 4% more were extubated from postoperative days 4 to 14, and almost 2% were receiving ventilation for > 14 days. Those risk factors that reflect preoperative medical instability, especially cardiac or respiratory insufficiency, were associated with the highest incidence of prolonged postoperative mechanical ventilation and for operative mortality. The Society of Thoracic Surgeons-predicted mortality estimate was the best single independent predictor for prolonged postoperative ventilation. CONCLUSIONS: Typically, patients can be expected to be extubated within 3 days after CABG. Certain preoperative comorbidities, especially preoperative cardiac or respiratory instability, are predictive of prolonged postoperative mechanical ventilation.     

Risk factors for distal stent graft-induced new entry following endovascular repair of type B aortic dissection

Background

Distal stent graft-induced new entry (DSINE) has been increasingly observed following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We seek to identify the risk factors for DSINE following TEVAR in patients with TBAD.

Methods

Between January 2009 and January 2013, we performed TEVAR for 579 patients with TBAD. The clinical data were retrospectively analyzed with univariate and multivariate analyses to identify the risk factors for DSINE.

Results

Two patients (0.3%) died after the initial TEVAR. Morbidity included spinal cord injury in 2 (0.3%), stroke in 3 (0.5%) and endoleak in 12 (2.1%) patients. Clinical and radiological follow-up was complete in 100% (577/577) averaging 47±16 months. Late death occurred in 6 patients. DSINE occurred in 39 patients (6.7%) at mean 22±17 months after the initial TEVAR, which was managed with re-TEVAR in 25 and medically in 14. At 33±18 months after DSINE, 11 of patients managed medically (11/14) and all patients managed with re-TEVAR (25/25) survived (P=0.048). Freedom from DSINE was 92.7% at 5 years (95% CI: 90.0-94.7%). Using tapered stent grafts with a proximal end 4-8 mm larger than the distal end, TEVAR performed in the acute phase (≤14 days from onset) was associated with a significantly lower incidence of DSINE than TEVAR performed in the chronic phase (4.3%, 7/185 vs. 13.9%, 15/108; P=0.003). Risk factors for DSINE were stent grafts less than 145 mm in length [odds ratio (OR) 2.268; 95% CI: 1.121-4.587; P=0.023] and TEVAR performed in the chronic phase (OR 1.935; 95% CI: 1.004-3.731; P=0.049).

Conclusions

Our results show that TEVAR performed during the acute phase and using stent grafts longer than 145 mm could decrease the incidence of DSINE in patients with TBAD. Tapered stent grafts with a proximal end 4-8 mm larger than the distal end may be helpful in preventing DSINE after TEVAR performed in the acute phase than TEVAR performed in the chronic phase, due to the difference in mobility of the dissected flap. Expedite repeat TEVAR is recommended to improve the clinical prognosis for patients with DSINE.     

急性Stanford A型主动脉夹层患者术后感染的危险因素分析

目的 分析急性Stanford A型主动脉夹层患者术后感染的危险因素。 方法 分析2017年6月～2019年12月本院收治的急性Stanford A型主动脉夹层接受外科手术治疗的患者（n = 104）,根据术后是否发生感染,将患者分为非感染组(n = 35)和感染组(n = 69)。 结果 与非感染组相比,感染组术前体温明显升高（P<0.05）;术中心肺转流（cardiopulmonary bypass,CPB）时间和主动脉阻断（aortic cross clamp,ACC）时间明显延长（P<0.01）,深低温停循环（deep hypothermic circulatory arrest,DHCA）时间明显延长（P<0.05）;术后机械通气时间、重症监护室（intensive care unit,ICU）住院时间和总住院时间明显延长（P<0.01）;术后急性肺损伤、急性肾损伤和全身炎症反应综合征（systemic inflammatory response syndrome,SIRS）发生率明显增高（P<0.01）。多因素Logistic回归分析发现:ICU住院时间（OR = 1.503,95%CI:1.013～2.230,P<0.05）和SIRS（OR = 11.635,95%CI:1.515～89.336,P<0.05）是急性Stanford A型主动脉夹层患者术后感染的独立危险因素。分析受试者工作特征曲线发现ICU住院时间的临界值为7.5 d,曲线下面积为0.865（P<0.01）。 结论 术后感染将明显不利于急性Stanford A型主动脉夹层患者的临床预后。ICU住院时间>7.5 d及术后出现SIRS是术后感染发生的独立危险因素。     

Outcome and function following prolonged mechanical ventilation

Prolonged periods of mechanically assisted ventilation are reasonably common occurrences, but there are no data regarding outcome for this patient population. We retrospectively reviewed the medical records of 250 consecutive patients with a minimum of ten days of ventilatory support during a five-year period. The overall survival was 39.2% at discharge, 28.6% at one year, and 22.5% at two years. Age and functional status prior to respiratory failure were the best predictors of survival. In addition, patients with postoperative or neurologic disease as the cause of respiratory failure were found to have the highest survival rate while those with cardiac and pulmonary disease had the worst prognosis. Of those patients who survived to discharge, 39.6% were institutionalized (nursing homes) and 32.7% were confined to their homes. Prolonged mechanical ventilation is associated with a limited survival and poor functional status in many who do survive.     

Clinical outcome of emergency surgery for complicated acute type B aortic dissection

BACKGROUND: The aim of the present study was to review the clinical profile and outcome of emergency surgery for complicated acute type B aortic dissection. METHODS AND RESULTS: A total of 34 consecutive patients requiring surgical treatment for complicated acute type B aortic dissection between 2003 and 2010 were examined. The median age was 64.0 years (range, 19-82 years). Indication for emergency surgery was aortic rupture in 11 patients, rapid expansion of the dissecting aorta in 5, dissection involving a non-dissecting aneurysm in 6, and organ malperfusion in 12. All of 3 patients with open aortic rupture died during surgery. Operative mortality was 9.7% (central operation, 14.2%; peripheral operation, 7.1%; thoracic endovascular aneurysm repair, 0%). There were 2 aortic ruptures within 1 week after operation. Two patients suffered from persistent organ malperfusion after emergency surgical relief of ischemia and died. The 1- and 5-year survival rates were 74.1 ± 8.1% and 64.8 ± 11.2%. The actual rate of freedom from aortic events at 1- and 5- years was 83.0 ± 7.0% and 58.7 ± 11.4%. Conclusions: Emergency surgery for complicated acute type B dissection still has a high mortality rate for patients with open rupture and critical visceral ischemia. Medical treatment is best given immediately after admission, and adequate surgical treatment without delay is crucial.     

心脏术后Stanford A型主动脉夹层的外科治疗

目的 总结心脏手术后A型主动脉夹层的治疗经验。方法 2006年12月至2019年03月,36例心脏术后A型主动脉夹层的患者接受二次手术治疗,男30例,女6例;年龄26-74岁,平均(53.8+11.3)岁。首次心脏手术为非主动脉夹层手术20例,包括主动脉瓣置换9例,二尖瓣置换3例,二尖瓣成形1例,双瓣置换3例,冠脉搭桥2例,主动脉根部替换1例和室间隔缺损修补1例。首次心脏手术为夹层手术的有16例,包括单纯升主动脉替换术后主动脉弓部扩张2例,升主动脉+右半弓替换术后弓部扩张11例,Bentall+孙氏手术后右冠吻合口漏1例,升主动脉+右半弓替换近端吻合漏1例,升主替换+孙氏手术后近端吻合口漏1例。本次手术距首次手术0.3-11年（5.6±3.2y）。结果 所有36例患者均施行了主动脉夹层手术,体外循环90-409min(平均224．5±78.7)min;主动脉阻断60-207min,(平均107．2+39．4)min。34例深低温停循环、低流量选择性脑灌注患者低流量时间16～47min,(平均25.6±8.2)min。死亡2例(5.6％);术后并发症6例(16.7％)。生存患者随访1～148个月（平均40.3+20.3m）,随访期间无夹层破裂、截瘫和死亡。结论 心脏手术后A型主动脉夹层患者或A 型主动脉夹层术后根部残余夹层或远端弓部扩张患者应及时手术治疗,但手术难度及风险均较初次主动脉手术增加,因此进行心脏手术时应特别注意主动脉操作的规范和准确,一旦心脏术后再发A型夹层则应尽量施行全弓支架象鼻手术,可获得较好的近远期临床效果。     

急性StanfordA型主动脉夹层患者体外循环术后急性肾损伤的危险因素分析

目的 分析急性StanfordA型主动脉夹层患者体外循环术后发生急性肾损伤的相关危险因素。方法 回顾性分析2016年7月至2018年12月哈尔滨医科大学附属第一医院心脏大血管外科收治的急性StanfordA型主动脉夹层手术患者的临床资料。根据KDIGO标准分为AKI组及非AKI组,将两组资料进行对比分析,探讨TA-AAD患者术后发生AKI的危险因素。结果 共入选患者134例,未发生AKI患者68例;发生AKI患者66例（49.3%）,其中24例患者需要肾脏替代治疗（CRRT）。AKI组死亡率明显高于非AKI组。单因素分析显示患者性别、术前血红蛋白以及高血压疾病史、体外循环时间、主动脉阻断时间、术后ICU停留时间、术后气管插管时间及术后死亡率差异有统计学意义。Logistic回归分析显示女性患者、高血压疾病史、术后气管插管时间为TA-AAD患者体外循环术后发生AKI的独立危险因素。 结论 女性患者、高血压疾病史、术后气管插管时间为TA-AAD患者体外循环术后发生AKI的独立危险因素。     

主动脉夹层发病相关危险因素分析

目的分析主动脉夹层(AD)发病相关危险因素的流行病学特点,以指导临床诊治。方法选择2017年1月~2019年6月我中心收治因胸痛就诊入院的患者733例,根据最终诊断,将确诊AD患者328作为病例组,非AD患者405例作为对照组,回顾性分析比较2组患者一般资料、既往病史和实验室指标,多因素logistic回归分析AD的影响因素。结果与对照组比较,病例组高血压、动脉粥样硬化、马方综合征、白塞病、主动脉瓣二叶畸形、大动脉炎、吸烟、饮酒比例、TC、TG、LDL-C水平明显升高,载脂蛋白A-Ⅰ和HDL-C水平明显降低(P<0.05,P<0.01)。logistic回归分析显示,高血压(OR=5.334,95%CI:3.757~7.574,P=0.000)、马方综合征(OR=4.681,95%CI:2.893~7.576,P=0.000)、主动脉瓣二叶畸形(OR=2.365,95%CI:1.476~3.812,P=0.000)、吸烟(OR=1.908,95%CI:1.164~3.126,P=0.010),载脂蛋白A-Ⅰ(OR=0.524,95%CI:0.320~0.859,P=0.010)和HDL-C(OR=0.187,95%CI:0.132~0.266,P=0.000)是AD的影响因素。结论高血压、马方综合征、主动脉瓣二叶畸形、吸烟是AD的独立危险因素,载脂蛋白A-Ⅰ和HDL-C是AD发病的独立保护因素。     

Myocardial infarction following acute aortic dissection

Acute aortic dissection may present a clinical picture simulating myocardial infarction, including electrocardiographic changes. The mechanism underlying this mode of presentation has not heretofore been documented during life. We present here for the first time, a patient with acute aortic dissection and the clinical picture of acute myocardial infarction, where the mechanism of infarction has been demonstrated, by preoperative angiographic studies, probably to be due to compression of the extramural portion of the right coronary artery by the false channel of the dissecting hematoma.     

Prompt surgery is effective for acute type A aortic dissection with cerebral ischemia

BackgroundAcute type A aortic dissection (aTAAD) with preoperative cerebral ischemia (CI) is common and lethal, but the timing and treatment method remain uncertain. We retrospectively reviewed our aTAAD patients with CI and analyzed the outcomes and related risk factors.MethodsFrom January 2011 to December 2019, 1,173 patients diagnosed with aTAAD from Nanjing Drum Tower Hospital were enrolled. Among them, 131 patients had CI preoperatively (CI group), and 1,042 patients were in the non-CI group. One hundred eight in the CI group and 984 in the non-CI group received central repair surgery. Fifteen patients had postoperative cerebral complications (CC) and 93 had non-CCs. ROC curves were used to identify the safe duration of preoperative CI.ResultsThe CI group was older (56.3 vs. 53.2 years, P=0.013) and had lower rates of pain, chest pain and back pain (77.9% vs. 94.4%, 75.4% vs. 87.5% and 30.8% vs. 42.3%, respectively) than the non-CI group. The CI group had a higher rate of preoperative hypotension and tamponade (13.7% vs. 6.0%, 26.9% vs. 10.4%, respectively; P=0.000). More patients in the CI group did not receive central repair surgery, and the CI had higher mortality (28.2% vs. 15.9%). CI without central repair surgery was a strong risk factor for mortality. CI patients with CC after central repair had a higher mortality, and preoperative coma was the strongest risk factor for postoperative CC.A duration between CI symptoms and central repair surgery of less than 12.75 hours is recommended.ConclusionsPrompt surgery is effective for aTAAD with CI, and preoperative coma and a safe duration longer than 12.75 hours would predict worse outcomes.