Does malperfusion syndrome affect early and mid-term outcome in patients suffering from acute type A aortic dissection?

Abstract

It is well known that malperfusion syndrome (MPS) increases early mortality of patients suffering from acute type A aortic dissection (AADA). The aim of the present study was to analyze the outcome of patients who survived after surgical treatment of AADA with or without MPS. Data of 227 consecutive patients, who underwent surgery for AADA, were analyzed. The impact of MPS on in-hospital data and outcome was analyzed. Quality of life (QoL), using the short form 36 health survey questionnaire (SF-36), and late mortality were analyzed. Seventy-five patients (33%) with AADA had preoperative MPS. In 31 patients (41.3%), central nervous system (CNS) was involved and in 33 patients (44%) MPS of the extremities was present. Coronary malperfusion was found in 9 patients, renal in 8 patients and visceral malperfusion in 5 patients. Mean age in the group with MPS was 61.9+/-9.1 compared to 61.6+/-12.7 years without MPS (P=ns). In-hospital mortality was 18.7% in patients with MPS, compared to 9.9% without MPS (P<0.05). Follow-up revealed a significant poorer outcome in patients with MPS, with a 3-year-survival of 73.3% in patients with MPS and 86.2% without MPS (P<0.05). Average SF-36 values were lower in patients with MPS (78.3+/-12.8 vs. 87.8+/-11.9; P=ns), which is mainly due to patients with CNS-MPS, who showed an average SF-36 of 65.8+/-17.9 (P<0.05). AADA associated to MPS carries a higher early- and mid-term mortality. Postoperative mid-term QoL, however, except in patients with CNS-MPS and persistent neurological deficits, is fairly good and similar to patients who underwent successful surgery for AADA without MPS.

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

“…According to literature, the incidence of brain malperfusion ranges from 7% to 14% (29,30,32,33), and significantly affected the therapeutic management. IRAD data (33) showed that nearly 1 out of 10 TAAD patients are complicated by major brain injury at onset of dissection [cerebrovascular accident (CVA) 4.7%; coma 2.9%], carrying a two or threefold higher mortality depending on presence of CVA or coma respectively.…”

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

“…They are most common in extensive DeBakey type I dissection (12,111). Clinically apparent malperfusion of any type increases mortality risk (107,109,111,112).…”

“…Although demonstration of radiological malperfusion might also be important, it is the ischemic consequences of malperfusion and end-organ dysfunction that compromise survival ( Fig. 4) (100,111,113,114). Thus, although a patient might have CT evidence of reduced true luminal (TL) innominate artery flow, the prognostic relevance of this is primarily determined (Online Table 2) by the presence of clinical neurological ischemia.…”

“…A precise cutoff time above which recovery is unlikely is undefined. A 10-h threshold below which neurological conservation and recovery might be higher has been suggested (116,138), but reperfusion is no guarantee that stroke will be prevented or that full independent rehabilitation will occur (111,116,139). Because speed of reperfusion is so important, early presenting ATAAD with brain malperfusion should have direct transfer to the operating room.…”

Temporary neurological dysfunction after surgery of the thoracic aorta: a predictor of poor outcome and impaired quality of life☆

“…Malperfusion syndrome (MPS) was diagnosed based on clinical symptoms pre-and perioperatively. The same definition for MPS was applied as in a recently published study from our group [15]. TND was defined as a Glasgow coma scale (GCS) value <13, these patients typically present with loss of orientation, slurred language, agitation and no clear response to commands.…”