Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations

Geirsson, Arnar; Szeto, Wilson Y.; Pochettino, Alberto; McGarvey, Michael L.; Keane, Martin; Woo, Y. Joseph; Augoustides, John; Bavaria, Joseph E.

doi:10.1016/j.ejcts.2007.04.012

Cited by 283 publications

(234 citation statements)

References 19 publications

Supporting

Mentioning

220

Contrasting

Unclassified

Order By: Relevance

“…Mesenteric malperfusion was identified as an independent predictor of operative mortality. Similarly, Geirsson et al [15] reported a 30.5% operative mortality in the presence of any malperfusion syndrome; in this study cerebral malperfusion was detected as a risk factor for in-hospital mortality (P < 0.001) and reduced long-term survival (P = 0.0002).…”

Section: [9]mentioning

confidence: 73%

The effect of postoperative malperfusion after surgical treatment of type A acute aortic dissection on early and mid-term survival

Nardi¹,

Olevano²,

Bassano³

et al. 2017

View full text Add to dashboard Cite

How to cite this article: Nardi P, Olevano C, Bassano C, Bovio E, Cecchetti L, Forlani S, Ruvolo G. The effect of postoperative malperfusion after surgical treatment of type A acute aortic dissection on early and mid-term survival. Vessel Plus 2017;1:77-83. Aim:To evaluate whether postoperative malperfusion (PM) affected in-hospital and longterm survival in acute type A aortic dissection (AAAD) surgical patients and to identify risk factors for PM. Methods: Patients who underwent AAAD surgery at a single institution between January 2005 and March 2015 were retrospectively analyzed. Results: Twohundred fourteen patients with complete data were identified. At presentation, 119 patients (55.6%) showed preoperative malperfusions: 68 (31.8%) were cerebral, 38 (17.7%) were renal, and 13 (6.1%) were mesenteric. PM was found in 55 patients (25.7%). In-hospital mortality was 47.3% (26/55) vs. 22.6% (36/159) in PM and non-PM patients, respectively (P < 0.0001). Independent predictors for in-hospital mortality included being 75 years or older [odds ratio (OR): 1.1, 95% confidence interval (CI): 1.03-1.13, P < 0.001] and having renal PM (OR: 53.5, 95% CI: 3.97-721.3, P < 0.01). Five-year survival was 78.6 ± 7.8% vs. 93.9 ± 3.4% in PM and non-PM patients, respectively (P < 0.001). Independent predictors for long-term survival were being at least 75 years old (OR: 3.7, 95% CI: 0.9-14.0, P = 0.05) and having renal PM (OR: 28.6, 95% CI: 1.8-462.0, P = 0.01). PM and intimal tears distal to the ascending aorta or the proximal aortic arch were also risk factors. Conclusion: PM, especially with renal involvement, is associated with in-hospital mortality and reduced long-term survival. AAAD surgeries reduced preoperative malperfusions. Sites of cannulation and interventions requiring circulatory arrest during cardiopulmonary bypass were not predictors of PM. Key words:Acute type aortic dissection, aortic surgery, malperfusion, survival ABSTRACTArticle history:

show abstract

Section: [9]mentioning

confidence: 73%

The effect of postoperative malperfusion after surgical treatment of type A acute aortic dissection on early and mid-term survival

Nardi¹,

Olevano²,

Bassano³

et al. 2017

View full text Add to dashboard Cite

show abstract

“…It is well documented that the presence of malperfusion increases mortality and postoperative complications. 34,35) Geirsson et al examined 221 surgical patients for AAAD, including 59 patients with malperfusion, and reported that in-hospital mortality was significantly higher in patients with malperfusion than in those without it (30.5% vs. 6.2%, P <0.001). 34) Along with immediate, aortic repair for preventing rupture, perfusion in an ischemic organ needs to be restored as early as possible.…”

Section: Malperfusionmentioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

View full text Add to dashboard Cite

Despite improved outcomes of acute type A aortic dissection (AAAD), many patients die at the moment of onset, and hospital mortality is still high. This article reviews the latest literature to seek the best possible way to optimize outcomes. Delayed diagnosis is caused by variation in or absence of typical symptoms, especially in patients with neurological symptoms. Misdiagnosis as acute myocardial infarction is another problem. Improved awareness by physicians is needed. On arrival, quick admission to the OR is desirable, followed by assessment with transesophageal echocardiography, and malperfusion already exists or newly develops in the OR; thus, timely diagnosis without delay with multimodality assessment is important. Although endovascular therapy is promising, careful introduction is mandatory so as not to cause complications. While various routes are used for the systemic perfusion, not a single route is perfect, and careful monitoring is essential. Surgical treatment on octogenarians is increasingly performed and produces better outcomes than conservative therapy. Complications are not rare, and consent from the family is essential. Prevention of AAAD is another important issue because more patients die at its onset than in the following treatment. In addition to hereditary diseases, including bicuspid aortic valve disease, the management of blood pressure is important.Keywords: aortic dissection, malperfusion, complication, echocardiography A cute type A aortic dissection (AAAD) not only causes sudden death at the time of onset but leads to various life-threatening complications. In spite of improved diagnostic imaging and surgical strategies, in-hospital mortality is still high, and patients who have survived often suffer from sequelae that make subsequent quality of life poor. This article is aimed to review the latest literature and ideas to seek the best possible way to minimize undesirable results.Various complications of AAAD caused by separation of the aortic wall to outer and inner layers are summarized as three categories: 1) aortic rupture due to disruption of the outer layer; 2) malperfusion caused by the inner layer, that is, the intimal flap; and 3) aortic regurgitation by a deformed aortic valve, leading to acute heart failure. Approximately 20% of patients instantaneously die due to aortic rupture, 1) and 1 to 2% of the remaining patients die every hour unless appropriately treated. 2) Although surgical outcomes are gradually improving, in-hospital mortality of surgical patients (repair on the aortic root to the arch) in 2009 was as high as around 10%, according to the Japanese database. 3) For the further improvement of outcomes, problems should be solved in each of preonset, pre-hospital, and in-hospital stages. In this review, the latter two stages are discussed first, since most of the literature focuses on these stages. After that, the issue of pre-onset stage, i.e., prevention is discussed. DelayeD DiagnosisIn consideration of the natural history of AAAD, the "chain of onset-to-sur...

show abstract

“…Approximately one-third of patients with acute type A aortic dissection develop malperfusion (1). The diagnosis of malperfusion can be made with a combination of patient history, physical examination, laboratory values and imaging findings.…”

Section: Incidence and Diagnosismentioning

confidence: 99%

“…The occurrence varies in the literature anywhere from 10-33% and can occur with both acute type A and type B dissection (1). The early diagnosis and characterization of the extent of malperfusion is essential in determining the initial modality of therapy for the patient.…”

Section: Introductionmentioning

confidence: 99%