Key result
Preoperative malperfusion syndrome linked to ~93% higher 30-day surgical mortality in type A aortic dissection.
Why the study?
This study was conducted to evaluate short- and long-term mortality in surgically treated type A aortic dissection with malperfusion and to identify specific malperfusion types associated with short-term mortality.
Does preoperative malperfusion syndrome increase short-term surgical mortality and long-term mortality in patients undergoing open surgical repair for type A aortic dissection?
Cohort (n=1,021)
Yes
Does preoperative malperfusion syndrome increase short-term surgical mortality and long-term mortality in patients undergoing open surgical repair for type A aortic dissection?
Preoperative malperfusion syndrome—particularly multiple-organ and isolated cerebral malperfusion—nearly doubles 30-day surgical mortality in patients undergoing open repair for type A aortic dissection, though postdischarge survival is comparable to patients without malperfusion.
Answers are grounded in this paper and cite their sources.
Preoperative malperfusion identifies higher-risk patients for perioperative counseling; extends subtype-specific mortality data but leaves open targeted interventions.
Background : This study evaluated short- and long-term mortality in type A aortic dissection with malperfusion (mTAAD) and identified malperfusion types associated with short-term mortality. Method : We analyzed 1,021 patients with TAAD who underwent open surgery in Asia from 2002 to 2018, including 209 with preoperative malperfusion and 812 without. The primary outcome was surgical mortality; secondary outcomes were postoperative and postdischarge all-cause mortality. Outcomes were assessed using logistic regression and Cox proportional hazards models. Results : Surgical mortality was higher in the malperfusion group than in the nonmalperfusion group (28.7% vs. 15.8%; adjusted odds ratio [aOR], 1.93; 95% CI, 1.32–2.84). Postoperative all-cause mortality was also higher in patients with malperfusion (34.4% vs. 24.0%; aOR, 1.36; 95% CI, 1.01–1.83). Cerebral, renal, lower limb, and multiple-organ malperfusion were associated with increased surgical mortality (aOR = 2.27, 2.09, and 1.95 and 16.01, respectively; 95% confidence interval [CI] = 1.18–4.38, 1.11–3.93, 1.13–3.36, respectively). Among patients with single-organ malperfusion, only cerebral malperfusion remained significantly associated with surgical mortality (aOR, 2.25; 95% CI, 1.08–4.70). Conclusions : Patients with mTAAD are at high risk of short- and long-term mortality. Cerebral malperfusion is associated with high short-term mortality and could be incorporated into risk stratification models to improve the prediction of short-term mortality in patients undergoing surgery for TAAD.
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Cheng et al. (2026) conducted a cohort in Type A aortic dissection (TAAD) undergoing open surgical repair (n=1,021). Preoperative malperfusion syndrome vs. No preoperative malperfusion syndrome was evaluated on Surgical mortality (death occurring within 30 days after surgery) (aOR 1.93, 95% CI 1.32-2.84, p=<0.05). Preoperative malperfusion syndrome increased 30-day surgical mortality (28.7% vs. 15.8%; aOR 1.93, 95% CI 1.32-2.84) in patients undergoing open surgery for type A aortic dissection.
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