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Malperfusion syndromes in type A aortic dissection: what we have learned from IRAD

Paolo Berretta1, Santi Trimarchi2, Himanshu J Patel3

  • 1Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy.

Journal of Visualized Surgery
|April 24, 2018
PubMed

Insights

Type A acute aortic dissection (TAAD) with malperfusion is a high-risk surgical condition. Outcomes remain poor, and optimal therapy for TAAD malperfusion is debated, necessitating further evidence assessment.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Type A acute aortic dissection (TAAD) with malperfusion presents significant surgical challenges.
  • End-organ ischemia from TAAD can affect multiple vital systems, leading to poor outcomes.
  • Despite advancements, management strategies for TAAD with malperfusion remain controversial.

Purpose of the Study:

  • To review current evidence on the management of Type A acute aortic dissection (TAAD) complicated by malperfusion syndromes.
  • To synthesize findings related to surgical and clinical outcomes in this high-risk patient cohort.
  • To provide insights based on data from the International Registry of Acute Aortic Dissection (IRAD).

Main Methods:

  • Literature review of studies focusing on TAAD with malperfusion.
  • Analysis of data from the International Registry of Acute Aortic Dissection (IRAD).
  • Assessment of diagnostic and management strategies for TAAD-related end-organ ischemia.

Main Results:

  • Patients with TAAD and malperfusion represent a high-risk surgical group.
  • Malperfusion can lead to ischemia in myocardial, cerebral, spinal cord, visceral, and limb circulations.
  • Surgical and clinical outcomes for TAAD with malperfusion remain suboptimal.

Conclusions:

  • Optimal therapy for TAAD with malperfusion is still debated.
  • Continuous improvement in diagnostic and management strategies is needed.
  • Further evidence assessment is crucial for improving outcomes in TAAD malperfusion patients.

Keywords:
Aortic dissectionInternational Registry of Acute Aortic Dissection (IRAD)aortic surgerymalperfusion syndrome

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