Surgical Delay for Acute Type A Dissection With Malperfusion

Deeb, G. Michael; Williams, David M.; Bolling, Steven F.; Quint, Leslie E.; Monaghan, Hilary; Sievers, Jennifer; Karavite, Dean; Shea, Michael J.

doi:10.1016/s0003-4975(97)01100-4

Cited by 232 publications

(185 citation statements)

References 12 publications

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“…This delayed treatment strategy involved early endovascular treatment with a complete or partial resolution of organ ischemia, followed by timely aortic surgeries. [16,17] While this management approach may be beneficial in a specific subpopulation, [18,19] Given the high mortality of patients with mesenteric malperfusion (40-100%), initial management with an interventional procedure treating the condition should be considered. [20,21] In fact, previous data suggested that mesenteric malperfusion was associated with the highest mortality rates when compared to malperfusions occurring in any other organ systems.…”

Section: [9]mentioning

confidence: 99%

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

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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:

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Section: [9]mentioning

confidence: 99%

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

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“…This will allow sufficient time to assess the extent of end-organ damage and perform any necessary ancillary procedures, such as exploratory laparotomy and resection of dead organs for end-stage mesenteric ischemia or fasciotomy and debridement of muscle tissue for limb ischemia, to establish metabolic stabilization prior to definitive open corrective procedure of the aorta. This stabilization period has varied in our experience from 24 hours to several months (2,5,6). …”

Section: Treatment Techniquesmentioning

confidence: 98%

“…In 1997, we described our early results for the strategy of operative delay for those patients presenting with acute type A dissection, malperfusion, and ischemic endorgan dysfunction (2). In that study, a historical cohort of patients presenting with ischemic end-organ dysfunction from malperfusion taken directly for open repair was compared with a cohort managed with initial percutaneous fenestration with aortic stenting, selective branch vessel stenting, and delayed operative repair after resolution of the perfusion injury.…”

Section: Acute Type a Dissectionmentioning

confidence: 99%

“…Longer time intervals between the actual episode of acute aortic dissection and subsequent diagnosis with treatment will result in a higher probability of irreversible endorgan ischemia with death of the patient. Patients who present with end-organ malfunction due to acute ischemia need immediate reperfusion with subsequent metabolic stabilization for the highest likelihood of survival (2).…”

Section: Introductionmentioning

confidence: 99%

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Management of type A dissection with malperfusion

Yang¹,

Patel²,

Williams³

et al. 2016

ASVIDE

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“…In some centers, patients with malperfusion are first treated endovascularly with fenestration and/or branch stenting and given an opportunity to stabilize before being offered surgery. 60 …”

Section: Surgical Therapy In Type a (I Or Ii) Acute Aortic Syndromesmentioning

confidence: 99%

Acute Aortic Syndromes and Thoracic Aortic Aneurysm

Ramanath

Sundt

et al. 2009

Mayo Clinic Proceedings

196

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Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. and studied by physicians for centuries. Descriptions of such pathologic conditions of the aorta as aneurysm and dissection date back as early as the 2nd century during the time of Galen, whose discoveries were largely made through studies of apes. More "recent" reports were described by Vesalius in 1557, followed by Nichols in 1732, who detailed the process of aortic dissection. In 1761, Morgagni reported detailed pathologic features of a patient with a ruptured aorta. 1 However, our true understanding of aortic pathology began with the dissertation by Shennan 2 in 1934, which included a description of penetrating atheromatous plaques of the thoracic aorta. His report was followed by the first successful management of aortic dissection by DeBakey in 1955. 1 Since then, our knowledge of the pathologic conditions of the aorta has grown considerably and continues to evolve with ongoing research into the pathophysiology of these conditions, technological advances in the modes of detection, and improved therapeutic options. Clinical databases, such as the International Registry of Acute Aortic Dissection (IRAD), the largest current registry for acute aortic syndromes, have also contributed tremendously to our knowledge of acute aortic pathology.For the practicing clinician, knowledge of aortic disease is paramount because patients with aortic conditions contribute significantly to the overall mortality from cardiovascular disease. This review discusses the pathophysiology, epidemiology, presentation, diagnosis, and therapeutic options for several forms of acute and chronic aortic pathology: aortic dissection (including its variants intramural hematoma [IMH] and penetrating atheromatous aortic ulcer) and thoracic aortic aneurysm (TAA). Literature searches were performed of the PubMed database using the following key words: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies conducted within the past 15 years, along with some data from years prior, were included in this review.

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Surgical Delay for Acute Type A Dissection With Malperfusion

Cited by 232 publications

References 12 publications

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

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

Management of type A dissection with malperfusion

Acute Aortic Syndromes and Thoracic Aortic Aneurysm

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