Interfacility Transfer and Mortality in Patients With Type A Acute Aortic Dissection　- Analysis of the Tokyo Acute Aortic Super-Network Database.

Background: Type A acute aortic dissection (TAAAD) requires integrated care and often interfacility transfer. However, the association between transfer and outcome remains unclear. Methods and Results: We analyzed 328 patients with TAAAD who were admitted within 48 h of onset and were enrolled in the Tokyo Acute Aortic Super-Network Database between November 2010 and October 2011. Patients with intramural hematoma, cardiopulmonary arrest before arrival, or those who refused surgery were excluded. Directly admitted patients who underwent fewer operations were more often treated at lower-volume institutes and experienced higher rates of respiratory failure and renal ischemia, with a shorter time from symptom onset to admission, than transferred patients. The 30-day mortality rate was higher in directly admitted patients (n=182) than in transferred patients (n=146; 25.8% vs. 14.4%; P=0.016). Logistic regression analysis identified age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; P=0.025), pre-arrival complications (OR 3.09; 95% CI 1.40-6.86; P=0.005), and surgery (OR 0.084; 95% CI 0.031-0.23; P<0.001) as independent predictors of 30-day mortality, while transfer status was not predictive (OR 0.836; 95% CI 0.345-2.02; P=0.69). Conclusions: Interfacility patient transfer did not appear to affect early mortality in patients with TAAAD; however, large scale studies are warranted to confirm this finding.