Malperfusion Syndrome in Patients with Acute Type A Aortic Dissection: Incidence and Mortality Rates after Surgical Repair

Background: Organ malperfusion is a well-known complication of acute Type A aortic dissection jeopardizing outcome after surgical repair. In this multicenter study we report rates of malperfusion syndrome according to the Penn classification and mortality in a large cohort of patients after surgical repair.

Methods: Data on organ malperfusion syndrome were retrieved form the multicenter European Registry of Type A Aortic Dissection (ERTAAD) including 18 participating European centers. Malperfusion was classified according to the Penn classification.

Results: A total of 3.902 consecutive patients underwent repair for Acute Type A Aortic Dissection, of whom 1780 (45.62%) presented with signs of preoperative malperfusion. Local malperfusion syndrome occurred in 1584 (40.58%) patients. Involvement of more than one organ occurred in 582 patients (36.74%) whereas 1002 patients (63.26%) had single organ malperfusion. The most frequent was the cerebral malperfusion (21.27%) followed by peripheral malperfusion (13.94%), myocardial (9.7%), renal (9.33%), mesenteric (4.15%) and spinal malperfusion (2.10%). In total of 687 (17.6%) global malperfusion (Penn C) was present whereas combination of local and general malperfusion occurred in 424 (10.86%) patients (Penn BC). Rates of in-hospital mortality increased with the severity of malperfusion as shown by the Penn classification: Penn A 12.38% (absence of any malperfusion); Penn B 20.71% (local malperfusion) (p < 0.0001 OR 1.878 CI 1.58 to 2.25) ; Penn C 28.90% (global malperfusion) (p < 0.0001 OR 2.64 CI 1.98 to 3.51); Penn B-C (combination of local and global malperfusion) 31.84% (p < 0.0001 OR. 3.15 CI 2.51 to 3.97).

Conclusion: Almost half of the cohort presents with signs of malperfusion syndrome mostly due to local involvement. More than one-third of patients with local malperfusion syndrome have multivessel involvement. Different levels of Penn classification can be used as valid predictors of mortality.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024