Outcomes of malperfusion in acute type A aortic dissection surgery

Objective The aim of this study was to explore the surgical outcomes and midterm survival of surgery approach on acute type A aortic dissection (ATAAD) patients complicated with malperfusion in real world. Methods We retrospectively enrolled patients who underwent emergency surgery for ATAAD at Nanjing First Hospital from 2019 to 2023. Based on the presence of malperfusion, patients were divided into two groups, the malperfusion (MPS) group and the non-MPS group. The preoperative characteristics, in-hospital mortality and morbidity and the mid-term survival were compared between the two groups. Results A total of 464 patients undergoing emergency aortic repair for ATAAD were enrolled in this study. 81 patients presented with malperfusion (17.5%), while 383 did not (82.5%). Patients with MPS had higher in-hospital mortality (21% vs 10.2%, P = 0.005) and lower midterm survival rate (68% vs 85%, P < 0.001). Univariable and multivariable Cox regression analysis showed that age, myocardial infarction, cardiogenic shock, preoperative intubation, cardiopulmonary bypass (CPB) time, re-CPB, and any vascular bed malperfusion were the independent predictors of in-hospital death. Patients with coronary, lower limb or visceral malperfusion had lower survival rate (P < 0.05). Conclusion Malperfusion was a severe fatal condition with higher in-hospital mortality and may reduce midterm survival in patients undergoing surgery for ATAAD. Patients with coronary, lower limb or visceral malperfusion had lower mid-term survival rate.