Does malperfusion syndrome affect early and mid-term outcome in patients suffering from acute type A aortic dissection?

It is well known that malperfusion syndrome (MPS) increases early mortality of patients suffering from acute type A aortic dissection (AADA). The aim of the present study was to analyze the outcome of patients who survived after surgical treatment of AADA with or without MPS. Data of 227 consecutive patients, who underwent surgery for AADA, were analyzed. The impact of MPS on in-hospital data and outcome was analyzed. Quality of life (QoL), using the short form 36 health survey questionnaire (SF-36), and late mortality were analyzed. Seventy-five patients (33%) with AADA had preoperative MPS. In 31 patients (41.3%), central nervous system (CNS) was involved and in 33 patients (44%) MPS of the extremities was present. Coronary malperfusion was found in 9 patients, renal in 8 patients and visceral malperfusion in 5 patients. Mean age in the group with MPS was 61.9+/-9.1 compared to 61.6+/-12.7 years without MPS (P=ns). In-hospital mortality was 18.7% in patients with MPS, compared to 9.9% without MPS (P<0.05). Follow-up revealed a significant poorer outcome in patients with MPS, with a 3-year-survival of 73.3% in patients with MPS and 86.2% without MPS (P<0.05). Average SF-36 values were lower in patients with MPS (78.3+/-12.8 vs. 87.8+/-11.9; P=ns), which is mainly due to patients with CNS-MPS, who showed an average SF-36 of 65.8+/-17.9 (P<0.05). AADA associated to MPS carries a higher early- and mid-term mortality. Postoperative mid-term QoL, however, except in patients with CNS-MPS and persistent neurological deficits, is fairly good and similar to patients who underwent successful surgery for AADA without MPS.