What is the clinical evidence from this study?

Study design: Cohort. Population: Acute type A aortic dissection (ATAAD) (n=483). Intervention: Malperfusion burden (multidistrict) vs. No malperfusion. Primary outcome: In-hospital mortality (p=<0.001).

What does this research mean for the field?

Malperfusion burden is associated with a stepwise increase in in-hospital mortality after emergency acute type A aortic dissection (ATAAD) repair, with distinct malperfusion territories conferring specific postoperative risks. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This investigation aims to understand how malperfusion patterns affect early outcomes following surgery for acute type A aortic dissection.

April 17, 2026Open Access

Impact of Malperfusion Burden on Early Outcomes After Surgery for Type A Acute Aortic Dissection: A Retrospective, Single-Center Investigation

Q: What are the key findings of this study?

Malperfusion burden was associated with a stepwise increase in in-hospital mortality after emergency ATAAD repair (12.7% for none, 19.8% for single-territory, and 50.0% for multidistrict; p<0.001).

Q: What does this research mean for the field?

Malperfusion burden is associated with a stepwise increase in in-hospital mortality after emergency acute type A aortic dissection (ATAAD) repair, with distinct malperfusion territories conferring specific postoperative risks. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This investigation aims to understand how malperfusion patterns affect early outcomes following surgery for acute type A aortic dissection.

Key Result

Malperfusion burden was associated with a stepwise increase in in-hospital mortality after emergency ATAAD repair (12.7% for none, 19.8% for single-territory, and 50.0% for multidistrict; p<0.001).

Key Points

This investigation aims to understand how malperfusion patterns affect early outcomes following surgery for acute type A aortic dissection.
Retrospective analysis of 483 patients undergoing emergency surgery for ATAAD from 2010 to 2022.
Classification of malperfusion into coronary, visceral, and peripheral territories.
Assessment of in-hospital mortality and major adverse events as primary and secondary outcomes respectively.
Multivariable logistic regression to identify independent predictors of outcomes.
31.3% of patients exhibited malperfusion, with a stepwise increase in in-hospital mortality (12.7%, 19.8%, and 50.0%) correlated with malperfusion burden.
Major adverse events occurred in 36.6% of patients, with an increasing trend based on malperfusion (31.2%, 46.2%, and 65.0%).
Preoperative shock and neurological deficit were significant predictors of major adverse events.

Study Design

Type

Cohort (n=483)

Multicenter

Structured PICO

Does malperfusion burden worsen early outcomes in patients undergoing emergency surgery for acute type A aortic dissection?

Population

483 consecutive patients undergoing emergency surgery for acute type A aortic dissection (ATAAD) between 2010–2022, mean age 65.4 ± 12.1 years, 68.5% male.

Intervention

Presence of malperfusion (single-territory or multidistrict) and territory-specific involvement (coronary, visceral, peripheral)

Comparator

No malperfusion

Outcome

In-hospital mortalityhard clinical

Malperfusion burden stepwise increases early mortality and adverse events after acute type A aortic dissection repair, highlighting the need for pattern-based perioperative risk stratification.

Main Result

Absolute Event Rate: 50% vs 12.7%

p-value: p=<0.001

Abstract

Objectives: Malperfusion is a major determinant of outcome in acute type A aortic dissection (ATAAD), yet its heterogeneous patterns and prognostic impact remain incompletely defined. We investigated the association between malperfusion burden, territory-specific involvement, and early outcomes after emergency ATAAD repair. Methods: We performed a retrospective single-center study including 483 consecutive patients undergoing emergency surgery for ATAAD (2010–2022). Malperfusion was classified by coronary, visceral, and peripheral territories and stratified as none, single-territory, or multidistrict (≥2 territories). The primary outcome was in-hospital mortality. Secondary outcomes included stroke, renal replacement therapy, peri-procedural myocardial infarction, major vascular events, and a composite endpoint of major adverse events (MAEs). Multivariable logistic regression identified independent predictors. Results: Overall, 68.5% of the population were male with a mean age of 65.4 ± 12.1 years. Malperfusion was present in 151 patients (31.3%), including 131 (27.1%) with single-territory and 20 (4.1%) with multidistrict involvement. In-hospital mortality increased stepwise with malperfusion burden (12.7%, 19.8%, and 50.0%; p < 0.001). MAEs occurred in 36.6% of patients, with a similar gradient (31.2%, 46.2%, and 65.0%, p < 0.001). In multivariable analysis, preoperative shock, neurological deficit, descending aortic involvement, and redo surgery were independent predictors of MAEs, whereas malperfusion burden showed an attenuated association after adjustment. Territory-specific analyses revealed strong associations between coronary malperfusion and peri-procedural myocardial infarction, visceral malperfusion and postoperative dialysis, and peripheral malperfusion and major vascular events. Conclusions: Malperfusion burden is associated with worse early outcomes after ATAAD repair but largely reflects underlying clinical severity. Distinct malperfusion territories confer specific postoperative risks, supporting a pattern-based approach to perioperative risk stratification.