Pre-operative malperfusion in acute type A aortic dissection significantly increased 30-day mortality, rising from 12.6% with no malperfusion to 43.4% with 3 affected organ systems (p<0.001).
Cohort (n=2,137)
Yes
Does pre-operative malperfusion increase 30-day mortality in patients undergoing surgery for acute type A aortic dissection?
Pre-operative malperfusion significantly increases 30-day mortality in patients undergoing surgery for acute type A aortic dissection, with the risk scaling proportionally to the number of affected organ systems.
p-value: p=<0.001
BACKGROUND: Malperfusion adversely affects outcomes in patients with acute type A aortic dissection, but reliable quantitative data are lacking. OBJECTIVES: The aim of this study was to analyze the impact of various forms of malperfusion on early outcome. METHODS: A total of 2,137 consecutive patients enrolled in GERAADA (German Registry for Acute Aortic Dissection Type A) who underwent surgery between 2006 and 2010, of whom 717 (33.6%) had any kind of pre-operative malperfusion, were retrospectively analyzed. RESULTS: All-cause 30-day mortality was 16.9% and varied substantially according to the number of organ systems affected by malperfusion (none, 12.6%; 1 system, 21.3%; 2 systems, 30.9%; 3 systems, 43.4%; p < 0.001). Pre-operative cerebral malperfusion, comatose state, peripheral malperfusion, visceral malperfusion, involvement of supra-aortic branches, coronary malperfusion, and renal malperfusion were all independent predictors of developing any post-operative malperfusion syndrome. When survival was considered, age, peripheral malperfusion, involvement of supra-aortic branches, coronary malperfusion, spinal malperfusion, a primary entry in the descending aorta, and pre-operative comatose state were independent predictors, again with increasing significance. CONCLUSIONS: Malperfusion remains a severe clinical condition with strong potential for adverse outcomes in patients undergoing surgery for acute type A aortic dissection. The GERAADA registry suggests that the impact of the number of organs involved and the type of malperfusion on outcome differs substantially. Introducing an appropriate classification system, such as "complicated" and uncomplicated" acute type A aortic dissection, might help predict individual risk as well as select a surgical strategy that may quickly resolve malperfusion.
Czerny et al. (Mon,) conducted a cohort in Acute type A aortic dissection (n=2,137). Pre-operative malperfusion vs. No pre-operative malperfusion was evaluated on All-cause 30-day mortality (p=<0.001). Pre-operative malperfusion in acute type A aortic dissection significantly increased 30-day mortality, rising from 12.6% with no malperfusion to 43.4% with 3 affected organ systems (p<0.001).