Martin Czerny1, Florian Schoenhoff2, Christian Etz3, Lars Englberger2, Nawid Khaladj4, Andreas Zierer5, Ernst Weigang6, Isabell Hoffmann7, Maria Blettner7, Thierry P Carrel2. 1. University Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland, and University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany. Electronic address: martin.czerny@uniklinik-freiburg.de. 2. University Clinic for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland. 3. Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. 4. Department for Cardiac Surgery, University Hospital Munich, Munich, Germany. 5. Division of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany. 6. Department of Vascular and Endovascular Surgery, Clinic Hubertus Hospital, Berlin, Germany. 7. Institute for Medical Biostatistics, Epidemiology and Informatics, Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
Abstract
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.
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.
Authors: Bo Yang; Carlo Maria Rosati; Elizabeth L Norton; Karen M Kim; Minhaj S Khaja; Narasimham Dasika; Xiaoting Wu; Whitney E Hornsby; Himanshu J Patel; G Michael Deeb; David M Williams Journal: Circulation Date: 2018-11-06 Impact factor: 29.690
Authors: R Scott McClure; Maral Ouzounian; Munir Boodhwani; Ismail El-Hamamsy; Michael W A Chu; Zlatko Pozeg; Francois Dagenais; Khokan C Sikdar; Jehangir J Appoo Journal: Aorta (Stamford) Date: 2017-04-01