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Single-Center Multidisciplinary Experience with Type A Dissections with Malperfusion.

Livia Brennan1, Ryan Wahidi2, Tullis Liu1

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|April 12, 2026
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Summary
This summary is machine-generated.

Malperfusion in acute Type A aortic dissection is linked to distal dissection zones and higher lactate levels. Early mortality was similar for patients with or without additional vascular surgery interventions.

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Thoracic Surgery

Background:

  • Acute Type A aortic dissection (AATAD) presents significant risks, particularly malperfusion of organs or limbs.
  • Understanding risk factors for malperfusion in AATAD is crucial for improving patient outcomes.
  • Current knowledge on specific risk factors and interventions for malperfusion in AATAD remains limited.

Purpose of the Study:

  • To identify risk factors associated with visceral and/or lower extremity malperfusion in patients with AATAD.
  • To review surgical interventions performed for malperfusion in this patient population.
  • To analyze outcomes related to malperfusion and surgical repair in AATAD.

Main Methods:

  • Retrospective analysis of 178 patients with AATAD from 2017-2023.
  • Data included demographics, dissection anatomy, neurovascular exams, and surgical repair details.
  • Malperfusion defined by clinical signs (limb) or radiographic evidence (visceral).

Main Results:

  • Malperfusion occurred in 20% of patients (n=36).
  • Malperfusion was significantly associated with distal dissection zone (p<0.001) and higher presentation lactate (p=0.02).
  • 22 cases (64.7%) of malperfusion resolved with Type A repair alone; 16 patients required fasciotomies, 8 extra-anatomic bypasses, and 1 amputation.

Conclusions:

  • Distal dissection zone and elevated lactate are key predictors of malperfusion in AATAD.
  • Vascular interventions may be necessary, but outcomes were similar regardless of additional surgery.
  • This study highlights the importance of recognizing risk factors for malperfusion in AATAD for timely management.