Abstract 20664: Early and Long-Term Outcomes of Acute Type a Aortic Dissection With Malperfusion According to Affected Organ System
Introduction: The management of malperfusion in patients with acute type A aortic dissection (ATAAD) is controversial. We sought to evaluate outcomes, to determine the rate of resolution of malperfusion , and to identify malperfusion sites that may be predictors of mortality.
Methods: A prospective study was conducted in 803 consecutive ATAAD patients during 2009 - 2014. Depending upon the anatomic site, malperfusion was identified by a combination of radiographic and clinical definitions. Data were analyzed using standard univariable and multivariable methods.
Results: 803 patients underwent repair of ATAAD. The most common repair strategies were ascending + total arch replacement + stented elephant trunk in 84.2% and hemiarch replacement in 13.6%. 30-day mortality was 4.86% ; there were two intraoperative deaths. Of the remaining 801 patients, 40.2% presented with at least one organ system of malperfusion. 30-day mortality was similar between patients with and without malperfusion [5.0% vs. 4.4%, P=0.13]. 322 patients who survived surgery presented with 358 sites of malperfusion. Anatomic sites included coronary (58), extremities (132), renal (103), cerebral (42) and intestinal (23). Coronary malperfusion resolved in 91.4% with coronary repair or additional bypass grafting. Renal malperfusion resolved radiographically in 89.3%. Extremity malperfusion resolved in 92 out of 132 patients. Of the remaining 40, concomitant extra anatomic bypass grafting was performed. Cerebral malperfusion resolved radiographically in 95.2% , twelve required additional cervical incision to obliterate carotid artery dissection. Advanced patient age (OR: 1.05, P=0.01), cerebral malperfusion (OR: 2.16, P=0.02), and intestine malperfusion (OR: 1.92, P=0.02) were independent predictors of 30-day mortality. During follow-up, Cox regression demonstrated that coronary malperfusion (HR:1.43) and intestine malperfusion (HR:1.65) were significant predictors of long-term mortality.
Conclusions: Malperfusion complicating ATAAD can be managed with low mortality.Organ malperfusion in most cases resolved following aortic repair. Patients presenting with preoperative coronary or cerebral malperfusion had poor long-term outcomes.
Author Disclosures: Y. Li: None. Q. Chang: None. X. Qian: None. X. Sun: None. C. Yu: None.
- © 2016 by American Heart Association, Inc.