Abstract 18429: The Impact of Preoperative Malperfusion on Outcome of Acute Type a Aortic Dissection - Results From Geraada
Introduction: Malperfusion may affect outcome in patients with acute type A aortic dissection (AAD). Reliable quantitative data are lacking
Hypothesis: Aim of the current study was to analyze the impact of various forms of malperfusion on outcome in patients undergoing surgery for AAD.
Methods: We retrospectively analyzed 2137 consecutive patients enrolled in the German Registry for Acute Aortic Dissection type A (GERAADA) who were operated between 2006-2010.
Results: Overall 30-day mortality was 16.9%. Mortality differed significantly according to the number of organ systems affected by malperfusion (n=0, 12.6%; n=1, 21.3%; n=2, 30.9%; n=3, 41.7%, p<0.0001). Preoperative peripheral malperfusion (OR 1.6, CI 1.1-2.2, p=0.008), comatous state (OR 1.6, CI 1.1-2.3, p=0.02), cerebral malperfusion (OR 1.6, CI 1.1-2.2, p=0.02), visceral malperfusion (OR 1.7, CI 1.1-2.7, p=0.03), extension of dissection into supraaortic branches (OR 1.7, CI 1.3-2.3, p=0.002), coronary malperfusion (OR 1.8, CI 1.2-2.7, p=0.004) and renal malperfusion (OR 2.5, CI 1.7-3.7, p<0.0001), were independent predictors of any persisiting postoperative malperfusion syndrome in increasing significance.
Age (OR 1.02, CI 1.01-1.03, p<0.0001), peripheral malperfusion (OR 1.4, CI 1.0-2.0, p=0.04), involvment of the supraaortic branches (OR 1.5, CI 1.1-1.9, p=0.004), coronary malperfusion (OR 1.6, CI 1.1-2.3, p=0.01), spinal malperfusion (OR 2.2, CI 1.1-4.3, p=0.03), primary entry in the descending aorta (OR 2.8, CI 1.4-5.6, p=0.004) and comatous state (OR 3.4, CI 2.5-4.7, p<0.0001) were independent predictors of decreased survival.
Conclusions: Malperfusion remains a strong condition for adverse outcome in patients undergoing surgery for AAD. Our data suggest that the impact of the number of organ systems involved as well as the type of malperfusion may substantially influence outcome. Additional classification such as “complicated” and uncomplicated” AAD might increase the individual risk assessment and help to choose the most appropriate malperfusion-oriented surgical strategy.
Author Disclosures: M. Czerny: None. F. Schönhoff: None. C. Etz: None. L. Englberger: None. N. Khaladj: None. A. Zierer: None. I. Hoffmann: None. M. Blettner: None. T. Carrel: None.
- © 2014 by American Heart Association, Inc.