Persistent malperfusion after central aortic repair in acute type I aortic dissections

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Aortic Disease

Background:

• Acute type I aortic dissections involve the ascending aorta and extend beyond the innominate artery.
• These dissections can lead to acute ischemic complications due to branch artery malperfusion.
• Noncardiac ischemic events necessitate evaluation and potential intervention by vascular surgery specialists.

Purpose of the Study:

• To determine the prevalence of noncardiac ischemic complications in acute type I aortic dissections.
• To assess the persistence of these ischemic complications after initial ascending aortic and hemiarch repair.
• To document the need for subsequent vascular surgery interventions for persistent ischemia.

Main Methods:

• A retrospective review of consecutive patients with acute type I aortic dissections from 2007 to 2022.
• Inclusion criteria: patients undergoing initial ascending aortic and hemiarch repair.
• Study end points: need for additional interventions post-repair and mortality.

Main Results:

• Out of 120 patients, 41 (34%) presented with acute ischemic complications, including leg, stroke, mesenteric, and arm ischemia.
• Twelve patients (10%) experienced persistent ischemia after proximal aortic repair, requiring further interventions.
• Persistent ischemia was associated with increased hospital mortality (25% vs. 0%, P = .02), while initial ischemia did not impact overall mortality.
• No additional interventions were needed for persistent branch artery occlusion during follow-up.

Conclusions:

• Approximately one-third of patients with acute type I aortic dissections develop noncardiac ischemia.
• Limb and mesenteric ischemia often resolve post-repair without further intervention.
• Persistent ischemia after central aortic repair serves as a marker for increased hospital mortality in type I aortic dissections.