Impact of an emergency department bypass referral pathway for surgically managed Type A aortic dissection diagnosed at non-aortic centers.

Objective: Surgical outcomes for Type A aortic dissection (TAAD) are significantly improved at high-volume aortic centers. Notably, approximately 60% of TAAD cases treated at these centers are referrals from outside hospitals, with nearly half presenting in an unstable condition upon arrival. To address critical delays in this population, our institution, in collaboration with the Chest Pain Center, implemented a regional Methods: We retrospectively analyzed medical records of TAAD patients diagnosed at non-aortic centers and transferred to our hospital for surgery between January 2018 and December 2023. Clinical outcomes before and after DBP implementation were compared. Results: The study included 144 patients in the Routine Referral Group and 149 in the Emergency Bypass Group. The two groups were well matched for demographics and comorbidities. Compared to the Routine Referral Group, the Emergency Bypass Group had a significantly shorter time from hospital arrival to surgery (8 h vs. 4 h, Conclusion: A coordinated, point-to-point referral model between the Chest Pain Center and the Aortic Center integrating streamlined pre-hospital triage and a dedicated aortic surgical team significantly improves outcomes for TAAD patients diagnosed at non-aortic centers.