Rapid Diagnosis and Treatment of Patients with Acute Type A Aortic Dissection and Malperfusion Syndrome May Normalize Survival to that of Patients with Uncomplicated Type A Aortic Dissection

Syed Usman Bin Mahmood; Makoto Mori; Jiajun Luo; Yawei Zhang; Basmah Safdar; Andrew Ulrich; Arnar Geirsson; John A. Elefteriades; Abeel A. Mangi

doi:10.1055/s-0039-1691790

AORTA, Table of Contents

CC BY 4.0 · Aorta (Stamford) 2019; 07(02): 042-048
DOI: 10.1055/s-0039-1691790

Original Research Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rapid Diagnosis and Treatment of Patients with Acute Type A Aortic Dissection and Malperfusion Syndrome May Normalize Survival to that of Patients with Uncomplicated Type A Aortic Dissection

Syed Usman Bin Mahmood

¹Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut

,

Makoto Mori

¹Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut

,

Jiajun Luo

²Section of Surgical Outcomes and Epidemiology, Yale School of Public Health, New Haven, Connecticut

,

Yawei Zhang

²Section of Surgical Outcomes and Epidemiology, Yale School of Public Health, New Haven, Connecticut

,

Basmah Safdar

³Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut

,

Andrew Ulrich

³Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut

,

Arnar Geirsson

¹Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut

,

John A. Elefteriades

¹Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut

,

Abeel A. Mangi

¹Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut

› Author Affiliations

Abstract

Objectives Malperfusion syndrome in the setting of acute Type A dissection (ATAD) is typically associated with poor prognosis. We evaluated the contemporary outcomes of patients with ATAD presenting with and without malperfusion syndrome who underwent aortic surgery.

Methods We performed a single-center, retrospective review of 103 consecutive patients that underwent surgery for ATAD. The cohort was dichotomized by patients with and without malperfusion syndromes. Multivariate and bivariate analyses were performed to evaluate association between the presence of malperfusion syndrome and operative outcomes.

Results A total of 29 (28.1%) patients presented with malperfusion syndrome. The 30-day mortality for patients presenting with and without malperfusion was 13.7 and 9.4%, respectively (p = 0.49). Patients with malperfusion syndrome had a shorter mean admission-to-incision interval of 4.3 ± 2.5 hours compared with 6.3 ± 4.6 hours for those without malperfusion (p = 0.02). Difference in 30-day mortality for patients with and without malperfusion syndrome was found to be nonsignificant on multivariate regression analysis (odds ratio: 1.53; 95% confidence interval: 0.40–5.82, p = 0.49).

Conclusions This series demonstrated that there was nonsignificant difference in early- or midterm outcomes for patients with and without malperfusion syndrome. Patients with malperfusion were taken to the operating room more rapidly than those without, which offers a potential explanation for the comparable outcome of the malperfusion cohort.

Keywords

Type A aortic dissection - malperfusion syndrome - ascending aortic replacement

Full Text

References

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