Malperfusion in acute type A aortic dissection: An update from the Nordic Consortium for Acute Type A Aortic Dissection

Zindovic, Igor; Guðbjartsson, Tómas; Ahlsson, Anders; Fuglsang, Simon; Gunn, Jarmo; Hansson, Emma C.; Hjortdal, Vibeke E.; Järvelä, Kati; Jeppsson, Anders; Mennander, Ari; Olsson, Christian; Pan, Emily; Sjögren, Johan; Wickbom, Anders; Geirsson, Arnar; Nozohoor, Shahab

doi:10.1016/j.jtcvs.2018.10.134

Cited by 86 publications

(74 citation statements)

References 28 publications

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“…In a recent report from the NORCAAD registry, preoperative cardiac malperfusion was found to be associated with the highest rates of 30-day mortality (33%) [7]. This was primarily driven by intraoperative deaths, possibly due to myocardial infarction and the inability to wean the patients off CPB.…”

Section: Complicationsmentioning

confidence: 98%

“…Patients who are clinically stable with normal perfusion syndrome generally do well after surgery, with low mortality (of around 3%) [59,60]. In contrast, in patients with unstable haemodynamics or preoperative malperfusion, the mortality is substantial (18-40%) [7,61].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…This was primarily driven by intraoperative deaths, possibly due to myocardial infarction and the inability to wean the patients off CPB. However, of the patients who survived surgery, only 7% suffered a perioperative myocardial infarction (MI) [7]. Di Eusanio et al reported that preoperative mesenteric malperfusion was associated with a mortality rate of 63.2% [96], while data from the NORCAAD registry showed a mortality rate of 31% in patients with gastrointestinal malperfusion [7].…”

Section: Complicationsmentioning

confidence: 99%

“…Thus, contemporary, sizeable, multicenter observational registries, of which NORCAAD is an example, stand out as important sources of information. This review covers different aspects of ATAAD, including epidemiology, pathophysiology, and surgical treatment, and concentrates especially on the NORCAAD studies that have been published so far [6][7][8][9][10][11][12][13]. We searched the PubMed and MEDLINE databases using the search terms "dissection," "aortic," "ascending," and "type A."…”

Section: Introductionmentioning

confidence: 99%

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Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

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105

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Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate. ARTICLE HISTORY Definitions and classification systemsDissection of the aorta occurs when the aortic media is separated, usually by pulsatile flow that penetrates the intimal layer of the aortic wall [14] (Figure 1(b)). This allows blood to flow between the layers of the aortic wall, forcing the layers apart, creating a false lumen parallel to the native (i.e. true) aortic lumen (Figure 1(b)). Consequently, the false lumen can propagate in both directions from the tear of intima and affect most of its distal branches, including the coronary, cerebral, and mesenteric arteries [15]. Another-but less common-CONTACT Tomas Gudbjartsson

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Section: Complicationsmentioning

confidence: 98%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

Self Cite

105

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show abstract

“…The potential to offer a type A dissection repair without any risk of reexploration for bleeding is enticing, although one questions whether the need to add a supplemental procedure for all patients is justified. Despite the historical reports of high ''take-back'' rates, [5][6][7] with meticulous care and precise technique, reoperative rates of 2% to 4% are increasingly reported. 8,9 Although accurate assessments of postoperative reexploration rates are difficult to ascertain (most type A series do not report bleeding rates), and the present series results remain to be replicated (or even extended), one is compelled to question whether the placing of an additional piece of foreign material in every patient is justified and what, if any, long term sequelae of fistula formation exist.…”

mentioning

confidence: 99%