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Author Spotlight: Advancing Spectral Characterization of Physiological and Malperfused Tissues
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Malperfusion in Type A Dissection: Consider Reperfusion First.

Joshua B Goldberg1, Steven L Lansman1, Masashi Kai1

  • 1Westchester Medical Center, Valhalla, New York; Section of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Valhalla, New York.

Seminars in Thoracic and Cardiovascular Surgery
|August 22, 2017
PubMed
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Acute type A aortic dissection (ATAAD) is a life-threatening condition. Malperfusion syndromes complicate ATAAD, requiring timely intervention to restore blood flow and prevent organ damage.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Thoracic Surgery

Background:

  • Acute type A aortic dissection (ATAAD) is a critical vascular emergency with high mortality.
  • Malperfusion syndromes (MPS) are a severe complication of ATAAD, affecting 20-50% of patients and significantly increasing mortality.
  • Coronary, cerebral, and visceral malperfusion are the most devastating forms of MPS in ATAAD.

Purpose of the Study:

  • To review the management strategies for malperfusion syndromes in acute type A aortic dissection.
  • To discuss the efficacy of central repair versus direct revascularization for resolving malperfusion.
  • To highlight the evolving role of emergency reperfusion in managing severe malperfusion.

Main Methods:

  • Review of current literature on ATAAD and malperfusion management.
Keywords:
aortic dissectionmalperfusionreperfusionsurgery

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  • Analysis of different surgical approaches including central repair, fenestration, and direct revascularization.
  • Discussion of treatment protocols and recent reports on emergency reperfusion strategies.

    • Main Results:

    • Emergency central aortic repair is the standard primary strategy for ATAAD to mitigate rupture risk.
    • Malperfusion can persist despite central repair, leading to significant end-organ damage.
    • In severe cases, mortality from end-organ damage may outweigh rupture risk, suggesting emergency reperfusion followed by central repair as a viable alternative.

    Conclusions:

    • While central repair is crucial for ATAAD, it may not always resolve malperfusion effectively.
    • Early recognition and management of coronary, cerebral, and visceral malperfusion are critical.
    • Emerging evidence supports emergency reperfusion of affected vascular beds as a potentially superior strategy for selected severe malperfusion cases.