Performance of the Open-first Repair Strategy in Type A Aortic Dissection with Mesenteric Malperfusion Syndrome Eligible for Delayed Repair.
Publication/Presentation Date
7-22-2024
Abstract
OBJECTIVE: For patients with Type A aortic dissection complicated by mesenteric malperfusion syndrome (MMPS), some centers advocate a non-traditional approach based on upfront endovascular intervention and delayed open repair. However, the efficacy of this strategy cannot be understood without first understanding outcomes of the traditional open-first strategy in the same select patient population eligible for delayed repair, applying modern techniques of hybrid aortic surgery.
METHODS: Patients with acute Type A aortic dissection and mesenteric malperfusion syndrome were queried from a single institution. Those presenting with aortic rupture, tamponade, or cardiogenic shock (ineligible for delayed repair) were excluded. Patients were managed with immediate open aortic repair. Short-term and long-term outcomes are reported.
RESULTS: A total of 1228 patients were treated for acute Type A dissection in the study period, of whom 77 were included in the MMPS cohort. In-hospital mortality was 29%, compared with 39% in an identically selected MMPS population undergoing delayed repair reported previously. Among MMPS patients, 32% underwent additional procedures addressing distal malperfusion in a hybrid operating room during or after open repair. Concomitant proximal malperfusion (coronary, cerebral, or upper extremity) was common in the MMPS cohort, present in 35% of cases. While early mortality was greater in the MMPS cohort compared to all acute Type A dissections, ten-year survival among those discharged alive was similar (65% vs 59%, p=0.18).
CONCLUSION: The traditional open-first repair strategy performs equal to or better than the delayed repair strategy for patients with MMPS eligible for delayed repair.
ISSN
1097-685X
Published In/Presented At
Goel, N. J., Yarlagadda, S., Bavaria, J. E., Freas, A. M., Kelly, J. J., Yildiz, M., Berezowski, M., Lutfi, W., DePaolo, J., Augoustides, J. G., Szeto, W. Y., & Desai, N. D. (2024). Performance of the Open-first Repair Strategy in Type A Aortic Dissection with Mesenteric Malperfusion Syndrome Eligible for Delayed Repair. The Journal of thoracic and cardiovascular surgery, S0022-5223(24)00630-5. Advance online publication. https://doi.org/10.1016/j.jtcvs.2024.07.030
Disciplines
Medicine and Health Sciences
PubMedID
39047861
Department(s)
Department of Surgery
Document Type
Article