Malperfusion in acute type A aortic dissection: An update from the Nordic Consortium for Acute Type A Aortic Dissection

: Igor Zindovic, Tomas Gudbjartsson, Anders Ahlsson, Simon Fuglsang, Jarmo Gunn, Emma C. Hansson, Vibeke Hjortdal, Kati Järvelä, Anders Jeppsson, Ari Mennander, Christian Olsson, Emily Pan, Johan Sjögren, Anders Wickbom, Arnar Geirsson, Shahab Nozohoor

Publisher: Elsevier

: 2019

: Journal of Thoracic and Cardiovascular Surgery

: The Journal of thoracic and cardiovascular surgery

: J Thorac Cardiovasc Surg

: 157

: 4

: 1324

: 1333

: 16

: 0022-5223

: 1097-685X

DOI: https://doi.org/10.1016/j.jtcvs.2018.10.134

Objectives
To evaluate the effect of preoperative malperfusion on 30-day and late mortality and postoperative complications using data from the Nordic Consortium for Acute Type A Aortic Dissection (ATAAD) registry.
Methods
We studied 1159 patients who underwent ATAAD surgery between January 2005 and December 2014 at 8 Nordic centers. Multivariable logistic and Cox regression analyses were performed to identify independent predictors of 30-day and late mortality.
Results
Preoperative malperfusion was identified in 381 of 1159 patients (33%) who underwent ATAAD surgery. Thirty-day mortality was 28.9% in patients with preoperative malperfusion and 12.1% in those without. Independent predictors of 30-day mortality included any malperfusion (odds ratio, 2.76; 95% confidence interval [CI], 1.94-3.93), cardiac malperfusion (odds ratio, 2.37; 95% CI, 1.34-4.17), renal malperfusion (odds ratio, 2.38; 95% CI, 1.23-4.61) and peripheral malperfusion (odds ratio, 1.95; 95% CI, 1.26-3.01). Any malperfusion (hazard ratio, 1.72; 95% CI, 1.21-2.43), cardiac malperfusion (hazard ratio, 1.89; 95% CI, 1.24-2.87) and gastrointestinal malperfusion (hazard ratio, 2.25; 95% CI, 1.18-4.26) were predictors of late mortality. Malperfusion was associated with significantly poorer survival at 1, 3, and 5 years (95.0% ± 0.9% vs 88.7% ± 1.9%, 90.1% ± 1.3% vs 84.0% ± 2.4%, and 85.4% ± 1.7% vs 80.8% ± 2.7%; log rank P = .009).
Conclusions
Malperfusion has a significant influence on early and late outcomes in ATAAD surgery. Management of preoperative malperfusion remains a major challenge in reducing mortality associated with surgical treatment of ATAAD.