Malperfusion in Patients with Acute Type A Aortic Dissection: A Nationwide Analysis.
Publication/Presentation Date
1-21-2025
Abstract
BACKGROUND: This study describes in detail the clinical burden of malperfusion associated with acute Type A aortic dissection (ATAAD) in a large, national cohort and the effect of treatment strategy on outcomes.
METHODS: All patients undergoing repair of ATAAD between 2017 and 2020 in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were studied. Malperfusion was defined using STS definitions based on imaging or surgeon's evaluation. Multivariable logistic regression was used to analyze the effect of patient and treatment factors on outcomes in patients with and without malperfusion.
RESULTS: A total of 9,958 patients undergoing ATAAD repair were studied. Preoperative malperfusion occurred in 27.7% (2,748/9,958) of cases and most often involved the extremity (14.9%, 1,484/9,958), renal (10.2%), or cerebral (9.8%) vascular beds. Operative mortality was much greater among malperfusion patients (26.8% vs 13.6%, P
CONCLUSIONS: Preoperative malperfusion in ATAAD was common and associated with significant operative mortality, which varied according to the malperfused region. Partial arch replacement, compared to ascending aorta or hemiarch replacement alone, was not associated with increased mortality.
ISSN
1552-6259
Published In/Presented At
Goel, N. J., Kelly, J. J., Patrick, W. L., Zhao, Y., Bavaria, J. E., Ouzounian, M., Estrera, A. L., Takayama, H., Chen, E. P., Reece, T. B., Hughes, G. C., Roselli, E. E., Kim, K. M., Patel, H. J., Bowdish, M. E., Sperling, J. S., Leshnower, B. G., Preventza, O., Brinkman, W. T., & Desai, N. D. (2025). Malperfusion in Patients with Acute Type A Aortic Dissection: A Nationwide Analysis. The Annals of thoracic surgery, S0003-4975(25)00066-9. Advance online publication. https://doi.org/10.1016/j.athoracsur.2025.01.002
Disciplines
Medicine and Health Sciences
PubMedID
39848556
Department(s)
Department of Surgery
Document Type
Article
