Mid-to-Long-Term Outcomes of Acute Type A Aortic Dissection Complicated by Preoperative Shock

Background: Acute type A aortic dissection (ATAAD) complicated by preoperative shock is associated with fatal outcomes. Preoperative shock is caused by coronary malperfusion, cardiac tamponade, and aortic rupture. However, there were few reports about mid-to-long-term outcomes in patients with ATAAD complicated by preoperative shock. Methods: Between October 2013 and November 2024, 181 patients with ATAAD underwent emergent aortic repair, including 44 (24.3%) with preoperative shock. Preoperative shock included cardiac tamponade, cardiopulmonary arrest, aortic rupture and coronary malperfusion. The mean age of patients was 60.4 ± 14.0 years. We analyzed postoperative outcomes in patients with ATAAD complicated by preoperative shock (shock group) compared to patients without shock (non-shock group). Results: Early mortality of the shock group was 43.2% (19/44), and 17.5% (24/137) in the non-shock group. There was a significant difference in early mortality between the two groups (p < 0.01). Logistic regression analysis demonstrated that older age and preoperative shock were significant predictors for early mortality (p < 0.01 and 0.02). The follow-up period was 34.0 ± 36.6 months. The cumulative survival rate in 10 years was 54.5% in the shock group, and 65.8% in the non-shock group. A significant difference was noted between the two groups (p < 0.01). On Cox proportional hazards regression analysis, preoperative shock was not an independent risk factor for cumulative survival. Conclusions: The mid-to-long-term survival rate of acute type A aortic dissection patients with preoperative shock was not inferior to that of patients without shock if they survived after the first aortic repair. Preoperative shock was a risk factor for early mortality in this patient cohort.