Malperfusion in Acute Type A Aortic Dissection: Management Strategies

Abstract

Over the decades, it has been well established that malperfusion complicates a number of acute type A aortic dissection (ATAAD) patients. Of the many complications that arise from ATAAD is malperfusion, which is the result of true lumen compression secondary to the dissection, and it is one of the most dangerous complications. Left untreated, malperfusion can eventually compromise circulation to the vascular beds of almost all vital organs. Clinicians must consider the diagnosis of malperfusion promptly following a diagnosis of acute aortic dissection. The outcomes post-surgery for patients with ATAAD with concomitant malperfusion remains poor, despite mortality for aortic surgery improving over time. Optimal management for ATAAD with associated malperfusion has yet to be implemented, further research is warranted to improve the detection and management of this potentially fatal pathology. In this review, we explore the literature surrounding the complications of malperfusion in ATAAD and the various symptom presentations, investigations, and management strategies available.

Validation of the German Registry for Acute Aortic Dissection Type A Score in predicting 30-day mortality after type A aortic dissection surgery

“…Clinical history, physical examination, laboratory test and imaging are all used to diagnose malperfusion and the latest can be differentiated in ‘simple’ malperfusion and malperfusion syndrome. While the ‘simple’ malperfusion can be defined as the reduction or the absence of blood flow to an organ, the malperfusion syndrome is the late stage of malperfusion with organ and tissue damage [ 19 , 20 ]. We suggest that the malperfusion syndrome may be underlined by the presence of clinical evidence, in addition to the radiological ones.…”

Development and validation of a prediction model for postoperative ischemic stroke following total arch replacement and frozen elephant trunk under mild hypothermia

“…However, they did not mention the results of single innominate artery. It is widely recognized that the occlusion or severe stenosis of supra-aortic branch vessels may be resulted from thrombosed dissection in the false lumen without forming re-entry, and it would lead to the cerebral malperfusion or even permanent neurological deficits [ [27] , [28] , [29] ]. The present study excluded patients who presented with coma or were diagnosed with acute ischemic stroke at the onset of ADIAD.…”

Safety and efficacy of two-stage type II hybrid aortic arch repair in elderly patients with acute type A aortic dissection: a propensity score-matched analysis

“…Studies have shown that the 48-h mortality rate of a-TAAD patients without surgery is as high as 50% (1)(2). The main causes of death are aortic rupture and failure of vital organs due to insu cient blood supply (11). Elderly a-TAAD patients usually with special conditions ( 12) such as preoperative complications, including chronic obstructive pulmonary disease, diabetes, cerebral infarction, organ dysfunction, etc., are more likely to incur organ injury after surgery.…”