Rapid Diagnosis and Treatment of Patients with Acute Type A Aortic Dissection and Malperfusion Syndrome May Normalize Survival to that of Patients with Uncomplicated Type A Aortic Dissection

Abstract

Objectives Malperfusion syndrome in the setting of acute Type A dissection (ATAD) is typically associated with poor prognosis. We evaluated the contemporary outcomes of patients with ATAD presenting with and without malperfusion syndrome who underwent aortic surgery.

Methods We performed a single-center, retrospective review of 103 consecutive patients that underwent surgery for ATAD. The cohort was dichotomized by patients with and without malperfusion syndromes. Multivariate and bivariate analyses were performed to evaluate association between the presence of malperfusion syndrome and operative outcomes.

Results A total of 29 (28.1%) patients presented with malperfusion syndrome. The 30-day mortality for patients presenting with and without malperfusion was 13.7 and 9.4%, respectively (p = 0.49). Patients with malperfusion syndrome had a shorter mean admission-to-incision interval of 4.3 ± 2.5 hours compared with 6.3 ± 4.6 hours for those without malperfusion (p = 0.02). Difference in 30-day mortality for patients with and without malperfusion syndrome was found to be nonsignificant on multivariate regression analysis (odds ratio: 1.53; 95% confidence interval: 0.40–5.82, p = 0.49).

Conclusions This series demonstrated that there was nonsignificant difference in early- or midterm outcomes for patients with and without malperfusion syndrome. Patients with malperfusion were taken to the operating room more rapidly than those without, which offers a potential explanation for the comparable outcome of the malperfusion cohort.

Keywords

Type A aortic dissection - malperfusion syndrome - ascending aortic replacement

Note

The abstract for this article was presented at the AATS Aortic Symposium 2018 (New York).

• References

• 1 Trimarchi S, Nienaber CA, Rampoldi V. , et al; International Registry of Acute Aortic Dissection Investigators. Contemporary results of surgery in acute type A aortic dissection: the International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg 2005; 129 (01) 112-122
• 2 Chikwe J, Cavallaro P, Itagaki S, Seigerman M, Diluozzo G, Adams DH. National outcomes in acute aortic dissection: influence of surgeon and institutional volume on operative mortality. Ann Thorac Surg 2013; 95 (05) 1563-1569
• 3 Patel HJ, Williams DM, Dasika NL, Suzuki Y, Deeb GM. Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: a long-term analysis. J Thorac Cardiovasc Surg 2008; 135 (06) 1288-1295, discussion 1295–1296
• 4 Cambria RP, Brewster DC, Gertler J. , et al. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 1988; 7 (02) 199-209
• 5 Fann JI, Sarris GE, Mitchell RS. , et al. Treatment of patients with aortic dissection presenting with peripheral vascular complications. Ann Surg 1990; 212 (06) 705-713
• 6 Nazerian P, Mueller C, de Matos Soeiro AM. , et al; ADvISED Investigators. Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes: the ADvISED Prospective Multicenter Study. Circulation 2018; 137 (03) 250-258
• 7 Imamura H, Sekiguchi Y, Iwashita T. , et al. Painless acute aortic dissection. Diagnostic, prognostic and clinical implications. Circ J 2011; 75 (01) 59-66
• 8 Conzelmann LO, Weigang E, Mehlhorn U. , et al; GERAADA Investigators. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 2016; 49 (02) e44-e52
• 9 Berretta P, Patel HJ, Gleason TG. , et al. IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg 2016; 5 (04) 346-351
• 10 Geirsson A, Ahlsson A, Franco-Cereceda A. , et al. Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection. Eur J Cardiothorac Surg 2018; 53 (01) 276-281
• 11 Lenos A, Bougioukakis P, Irimie V, Zacher M, Diegeler A, Urbanski PP. Impact of surgical experience on outcome in surgery of acute type A aortic dissection. Eur J Cardiothorac Surg 2015; 48 (03) 491-496
• 12 Rylski B, Beyersdorf F, Kari FA, Schlosser J, Blanke P, Siepe M. Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair. J Thorac Cardiovasc Surg 2014; 148 (03) 949-954 , discussion 954
• 13 Haldenwang PL, Wahlers T, Himmels A. , et al. Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients. Eur J Cardiothorac Surg 2012; 42 (05) e115-e120
• 14 Yang B, Patel HJ, Williams DM, Dasika NL, Deeb GM. Management of type A dissection with malperfusion. Ann Cardiothorac Surg 2016; 5 (04) 265-274
• 15 Midulla M, Renaud A, Martinelli T. , et al. Endovascular fenestration in aortic dissection with acute malperfusion syndrome: immediate and late follow-up. J Thorac Cardiovasc Surg 2011; 142 (01) 66-72