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Management of malperfusion: New York approach and outcomes

Erin Iannacone1, Bryce Robinson1, Mohamed Rahouma1

  • 1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.

Journal of Cardiac Surgery
|September 19, 2020
PubMed

Insights

Surgical repair of acute type A aortic dissection (ATAAD) with malperfusion significantly increases operative mortality and major adverse events. Rapid diagnosis and ischemia reversal are crucial for improving outcomes in this high-risk patient group.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease

Background:

  • Aortic branch malperfusion complicates up to one-third of acute type A aortic dissection (ATAAD) cases.
  • Malperfusion in ATAAD is a strong predictor of adverse outcomes.
  • Surgical management of ATAAD with malperfusion represents a high-risk clinical scenario.

Purpose of the Study:

  • To analyze the outcomes of surgical management for patients with ATAAD and malperfusion.
  • To compare the characteristics and outcomes of ATAAD patients with and without malperfusion.
  • To identify predictors of major adverse events in ATAAD patients.

Main Methods:

  • Retrospective analysis of a consecutive patient cohort undergoing ATAAD repair from 1997 to 2019.
  • Comparison of patients presenting with malperfusion versus those without.
  • Univariate and multivariate analyses to assess outcomes and predictors of major adverse events.

Main Results:

  • Malperfusion patients were more likely to be male, have prior myocardial infarction, renal dysfunction, and shock.
  • Higher rates of coronary artery bypass grafting and non-cardiac procedures were observed in the malperfusion group.
  • Operative mortality (15.5% vs. 0.8%) and major adverse events (20.6% vs. 7.6%) were significantly greater in patients with malperfusion.

Conclusions:

  • Surgical repair of ATAAD with malperfusion is associated with substantially higher mortality and morbidity.
  • Cerebral, coronary, and mesenteric malperfusion are significant predictors of major adverse events.
  • Prompt diagnosis and reversal of ischemia are essential for improving outcomes in this high-risk population.
Abstract

Keywords:
aorta and great vesselsaortic aneurysmaortic repairmalperfusion syndrometype A dissection

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