Malperfusions in Acute Type B Aortic Dissection-Predictors of Outcomes

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Medicine

Background:

• Acute type B aortic dissection (AoD) with malperfusion is a rare, complex condition requiring invasive treatment.
• Thoracic endovascular aortic repair (TEVAR) aims to restore flow by excluding the entry tear.
• This study investigates TEVAR outcomes and predictors in AoD with malperfusion.

Purpose of the Study:

• To evaluate the outcomes of patients undergoing TEVAR for acute type B AoD with malperfusion.
• To identify preoperative and intraoperative predictors of prognosis in these patients.

Main Methods:

• Retrospective study of 41 patients treated with TEVAR across two European centers (March 2005-January 2016).
• Analysis of preoperative, intraoperative, and postoperative data, including 3D CT angiogram reanalysis.
• Logistic regression used to assess factors affecting 30-day malperfusion-related complications and mortality.

Main Results:

• The 30-day mortality rate was 17.1%, primarily due to malperfusion.
• The number of malperfusion syndromes was the sole independent predictor of increased 30-day mortality (HR=30.3 for 3 vs 1, HR=9.9 for 3 vs 2).
• Renal ischemia was the most common malperfusion syndrome (53.6%).

Conclusions:

• Patients with acute type B AoD and malperfusion face a severe prognosis, particularly with multiple ischemic territories.
• Early identification of malperfusion complications is crucial for survival.
• Current criteria for early identification lack definitive guidelines.