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Updated: Jul 5, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Optimized strategy to improve the outcomes of acute type A aortic dissection with malperfusion syndrome
Shuangkun Chen1, Hua Peng1, Hui Zhuang1
1Department of Cardiac Surgery, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Background:
The mortality of acute type A aortic dissection (ATAAD) with malperfusion syndrome (MPS) is high. However, the management strategy remains controversial. We aimed to evaluate the strategy for MPS at our institution.
Methods:
Among 724 patients with ATAAD, 167 patients with MPS were treated with immediate central repair (first stage) or an optimized strategy (second stage). In the second stage, the optimized strategy used was based on 6-hour threshold from symptom onset. For MPS with symptom onset within 6 hours, immediate central repair was performed, followed by endovascular reperfusion if malperfusion persisted. With symptom onset beyond 6 hours, individualized delayed central repair was performed. We compared outcomes between the first and second stages.
Results:
The in-hospital mortality of ATAAD was significantly decreased when the optimized strategy was used (4.3% in the second stage vs 12.5% in the first stage; P < .01). In the second stage, the in-hospital mortality for MPS was decreased (10.2% vs 33.9%; P < .01). Moreover, the in-hospital mortality for MPS with symptom onset within 6 hours and beyond 6 hours decreased from 24% to 7.5% and from 41.2% to 11.8%, respectively. The operative mortality of MPS in the second stage was comparable to that in patients without MPS (4.0% vs 2.4%; P > .05).
Conclusions:
The optimized strategy significantly improved the outcomes of MPS. The 6-hour threshold from symptom onset could be very useful in determining the timing of central repair. For patients with MPS symptom onset within 6 hours, immediate central repair is reasonable; for those with symptom onset beyond 6 hours, individualized delayed central repair should be considered.
Insights
An optimized strategy for acute type A aortic dissection with malperfusion syndrome significantly reduced mortality. This approach uses a 6-hour threshold from symptom onset to guide timing of central repair, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease Management
Background:
- Acute type A aortic dissection (ATAAD) with malperfusion syndrome (MPS) carries a high mortality rate.
- Current management strategies for ATAAD with MPS remain a subject of debate.
- Evaluating institutional strategies for MPS in ATAAD is crucial for improving patient survival.
Purpose of the Study:
- To assess the effectiveness of an optimized management strategy for malperfusion syndrome in patients with acute type A aortic dissection.
- To compare outcomes between immediate central repair and an optimized strategy based on symptom onset time.
- To determine the utility of a 6-hour time threshold in guiding surgical timing for ATAAD with MPS.
Main Methods:
- A retrospective analysis of 724 patients with ATAAD, focusing on 167 patients with MPS.
- Patients were divided into two groups: immediate central repair (first stage) and an optimized strategy (second stage).
- The optimized strategy involved immediate central repair for MPS within 6 hours of symptom onset, or individualized delayed repair for onset beyond 6 hours, with endovascular reperfusion as needed.
Main Results:
- The optimized strategy significantly decreased in-hospital mortality for ATAAD (4.3% vs 12.5%) and specifically for MPS (10.2% vs 33.9%).
- Mortality for MPS within 6 hours decreased from 24% to 7.5%, and beyond 6 hours from 41.2% to 11.8% with the optimized strategy.
- Operative mortality for MPS under the optimized strategy was comparable to patients without MPS (4.0% vs 2.4%).
Conclusions:
- An optimized management strategy significantly enhances outcomes for patients with acute type A aortic dissection and malperfusion syndrome.
- A 6-hour time threshold from symptom onset is a valuable guide for determining the optimal timing of central repair.
- Immediate central repair is appropriate for MPS within 6 hours, while individualized delayed repair should be considered for onset beyond 6 hours.
