Acute type A aortic dissection: significance of multiorgan malperfusion

Pacini, Davide; Leone, Alessandro; Belotti, Laura Maria Beatrice; Fortuna, Daniela; Gabbieri, Davide; Zussa, Claudio; Contini, Andrea; Bartolomeo, Roberto Di

doi:10.1093/ejcts/ezs500

Cited by 104 publications

(73 citation statements)

References 26 publications

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“…Although mesenteric ischemia is a fairly rare complication, it is very often associated with clinical or imaging signs of other organ injury or malperfusion making the prognosis really unfavorable (34,35). In such patients, when compared with medical therapy, surgery or hybrid management (central aortic operation with percutaneous treatment of mesenteric malperfusion) was associated with better outcomes.…”

Section: Resultsmentioning

confidence: 99%

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

Berretta¹,

Patel²,

Gleason³

et al. 2016

Ann. Cardiothorac. Surg.

148

103

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Type A acute aortic dissection (TAAD) is a disease that has a catastrophic impact on a patient's life and emergent surgery represents a key goal of early treatment. Despite continuous improvements in imaging techniques, medical therapy and surgical management, early mortality in patients undergoing TAAD repair still remains high, ranging from 17% to 26%. In this setting, the International Registry of Acute Aortic Dissection (IRAD), the largest worldwide registry for acute aortic dissection, was established to assess clinical characteristics, management and outcomes of TAAD patients. The present review aimed to evaluate and comment on outcomes of TAAD surgery as reported from IRAD series.

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Section: Resultsmentioning

confidence: 99%

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

Berretta¹,

Patel²,

Gleason³

et al. 2016

Ann. Cardiothorac. Surg.

148

103

View full text Add to dashboard Cite

show abstract

“…Almost all of the deaths were caused by organ ischemia from malperfusion that had been present before the operation. [21][22][23] In this study, the surgical mortality rate was acceptable, at 8.8% in the FA group and 4.3% in the TAA group. Regarding the risk of postoperative stroke, six cases in the FA group (17%) and five cases (11%) in the TAA group had some neurological dysfunction.…”

Section: Discussionmentioning

confidence: 51%

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

Suenaga

Sato

Fumoto

et al. 2015

ATCS

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consecutive patients with AAAD were underwent the ascending aortic replacement at Nagasaki Kouseikai Hospital. These patients were divided into two groups according to the cannulation site, FA cannulation (n = 34) and TAA cannulation (n = 46). Early and mid-term outcomes were compared between two groups. Result: Preoperative patient characteristics were almost comparable between groups. The time from skin incision to starting cardiopulmonary bypass (CPB) was significantly shorter in the TAA group (45 ± 16 vs 23 ± 5.1 min; P <0.001). There were no significant differences in post-operative cerebral infarction in two groups (17% versus 11%; P = NS). The operative mortality rate was 8.8% in FA group and 4.3% in TAA group (P = NS). During follow up (mean, 6.8 years), survival at 3 years and 5 years was 77.4% and 71.9% in TAA group and 76.3% and 73.8% in FA group, respectively. Conclusion: The postoperative morbidity and mortality between the two groups were almost the same. TAA cannulation for acute Type A aortic dissection is faster, easy and safe with acceptable early and mid-term outcome.

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“…Patients with malperfusion had longer hospital lengths of stay {20 vs. 12 [8][9][10][11][12][13][14][15][16][17][18] days, P=0.006}, as well as more reoperations for postoperative hemorrhage (24.0% vs. 5.6%, P=0.01) and a greater number of postoperative CNS events (44.0% vs. 18.3%, P=0.01).…”

Section: Resultsmentioning

confidence: 99%

Differential outcomes of type A dissection with malperfusion according to affected organ system

Grimm¹,

Magruder²,

Crawford³

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The management of malperfusion in patients with acute Stanford type A aortic dissection is controversial. We sought to determine the rate of resolution of malperfusion following primary repair of the dissection and to identify anatomic sites of malperfusion that may require additional management. Methods:We reviewed the hospital records of patients who presented to our institution with acute type A aortic dissection. Patient demographics, operative details and post-operative course were retrospectively extracted from our institutional electronic database. Depending upon the anatomic site, malperfusion was identified by a combination of radiographic and clinical definitions. Data were analyzed using standard univariable and multivariable methods. Conclusions: Malperfusion complicating acute type A dissection can be managed in many patients by aortic replacement alone with low overall mortality. Most cases of renal and cerebral malperfusion resolved following aortic surgery. Revascularization was frequently necessary in patients with extremity malperfusion.Patients presenting with intestinal ischemia had very poor outcomes. A patient-specific approach is recommended in such complex patients.

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Acute type A aortic dissection: significance of multiorgan malperfusion

Cited by 104 publications

References 26 publications

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

Differential outcomes of type A dissection with malperfusion according to affected organ system

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