Immediate operation for acute type A aortic dissection complicated by visceral or peripheral malperfusion

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Acute type A aortic dissection is a life-threatening condition.
• Malperfusion syndromes complicate type A aortic dissection, affecting visceral, renal, or peripheral arteries.
• The impact of malperfusion on outcomes requires further evaluation.

Purpose of the Study:

• To assess the effect of visceral, renal, or peripheral malperfusion on outcomes in patients with acute type A aortic dissection.
• To compare in-hospital mortality, midterm survival, and reintervention rates between patients with and without malperfusion.

Main Methods:

• Retrospective review of 305 patients with acute type A aortic dissection (2005-2015).
• Inverse probability weighting to adjust for baseline differences.
• Weighted logistic regression, restricted mean survival time, and weighted Cox regression for outcome analysis.

Main Results:

• 82 patients (26.9%) presented with malperfusion syndrome.
• No significant difference in in-hospital mortality (OR, 1.50; P=.3) or 8-year midterm survival (P=.8) between groups.
• Patients with malperfusion had a higher risk of aortic branch reintervention (HR, 3.06; P=.02) with a median time of 2 days versus 230 days.

Conclusions:

• Acute type A aortic dissection with malperfusion syndrome is associated with good immediate outcomes after operation.
• Malperfusion does not significantly increase mortality but necessitates more frequent and earlier reinterventions on aortic branches.