The Impact of Pre-Operative Malperfusion on Outcome in Acute Type A Aortic Dissection: Results From the GERAADA Registry

Czerny, Martin; Schoenhoff, Florian; Etz, Christian; Englberger, Lars; Khaladj, Nawid; Zierer, Andreas; Weigang, Ernst; Hoffmann, Isabell; Blettner, Maria; Carrel, Thierry P. (2015). The Impact of Pre-Operative Malperfusion on Outcome in Acute Type A Aortic Dissection: Results From the GERAADA Registry. Journal of the American College of Cardiology, 65(24), pp. 2628-2635. Elsevier 10.1016/j.jacc.2015.04.030

Text 1-s2.0-S073510971502029X-main.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (661kB)

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.

Interest & Impact

Downloads

2 since deposited on 14 Dec 2015
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item