Management of type A dissection with malperfusion

Abstract

Malperfusion is a common lethal complication of acute aortic dissection following rupture, for which the optimal management strategy has yet to be clearly established. The objective of this study was to reassess the management of acute type A aortic dissection (Type A-AAD) with malperfusion. We retrospectively

Total aortic arch replacement with frozen elephant trunk technique: Results from two European institutes

“…In our series, the mortality rate was higher (17.5%), but we had a higher incidence of preoperative malperfusion syndrome, which is known to be a lethal complication for which the optimal management strategy has yet to be clearly established. 22 Yang and colleagues 23 recently showed their results in the delayed treatment of acute dissections after implantation of the stent in the true lumen. 23 Their results support the notion that the complication of malperfusion with end-organ dysfunction carries a high mortality risk irrespective of early reperfusion, stabilization, and delayed surgical reconstruction.…”

“…22 Yang and colleagues 23 recently showed their results in the delayed treatment of acute dissections after implantation of the stent in the true lumen. 23 Their results support the notion that the complication of malperfusion with end-organ dysfunction carries a high mortality risk irrespective of early reperfusion, stabilization, and delayed surgical reconstruction. Visceral ischemia can go unnoticed because preoperative symptoms are often ambiguous and may become exacerbated without discernible symptoms during surgery.…”

Predictors of Prolonged Mechanical Ventilation in Adults After Acute Type-A Aortic Dissection Repair—Implications for the Future

“…There is a large difference in mortality in looking at these 3 groups, with published rates demonstrating early mortality of ATAAD with class "a" of roughly 10% compared to patients with class b or c characteristics having mortality of 38% percent or higher. 8,9 This is an important distinction when comparing studies that look at mortality outcomes in ATAAD such as the current study by Jin et al in this month's issue of JCVA. 10 The authors retrospectively reported on 121 patients who underwent surgical repair for ATAAD with Penn class Aa dissections.…”

Successful Primary PCI in Stanford Type A Aortic Dissection Complicated by Inferior ST-Elevation Myocardial Infarction: A Case in a Facility with No Surgical Backup

“…Stenting or fenestration to restore flow into malperfused vital organs followed by delayed corrective surgery resulted in lower mortality than direct definitive treatment. [6][7][8] In a study by Uchida et al, in-hospital mortality of patients with TAAD complicated by a malperfusion syndrome who underwent surgery was five times greater than those without malperfusion syndrome. Early reperfusion before surgery was able to significantly lowered the mortality to similar levels of patients without malperfusion syndrome.…”