Malperfusion in acute type A aortic dissection: An update from the Nordic Consortium for Acute Type A Aortic Dissection

The Journal of Thoracic and Cardiovascular Surgery

Anders Ahlsson¹  Igor Zindovic²  Emma C. Hansson³  Simon Fuglsang⁴  Kati Järvelä⁵  Vibeke Hjortdal⁶  Jarmo Gunn⁷  Tomas Gudbjartsson⁸  Anders Jeppsson⁹ 

[1] Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital and School of Health and Medicine, Orebro University, Orebro, Sweden;Department of Clinical Sciences and Department of Cardiothoracic Surgery, Lund University, Skane University Hospital, Lund, Sweden;Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark;Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden;Heart Center, Tampere University Hospital, Tampere, Finland;Heart Center, Turku University Hospital and University of Turku, Turku, Finland;Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland;Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn

关键词: aorta;    dissection;    malperfusion;   

DOI  :  10.1016/j.jtcvs.2018.10.134

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectivesTo evaluate the effect of preoperative malperfusion on 30-day and late mortality and postoperative complications using data from the Nordic Consortium for Acute Type A Aortic Dissection (ATAAD) registry.MethodsWe studied 1159 patients who underwent ATAAD surgery between January 2005 and December 2014 at 8 Nordic centers. Multivariable logistic and Cox regression analyses were performed to identify independent predictors of 30-day and late mortality.ResultsPreoperative malperfusion was identified in 381 of 1159 patients (33%) who underwent ATAAD surgery. Thirty-day mortality was 28.9% in patients with preoperative malperfusion and 12.1% in those without. Independent predictors of 30-day mortality included any malperfusion (odds ratio, 2.76; 95% confidence interval [CI], 1.94-3.93), cardiac malperfusion (odds ratio, 2.37; 95% CI, 1.34-4.17), renal malperfusion (odds ratio, 2.38; 95% CI, 1.23-4.61) and peripheral malperfusion (odds ratio, 1.95; 95% CI, 1.26-3.01). Any malperfusion (hazard ratio, 1.72; 95% CI, 1.21-2.43), cardiac malperfusion (hazard ratio, 1.89; 95% CI, 1.24-2.87) and gastrointestinal malperfusion (hazard ratio, 2.25; 95% CI, 1.18-4.26) were predictors of late mortality. Malperfusion was associated with significantly poorer survival at 1, 3, and 5 years (95.0% ± 0.9% vs 88.7% ± 1.9%, 90.1% ± 1.3% vs 84.0% ± 2.4%, and 85.4% ± 1.7% vs 80.8% ± 2.7%; log rank P = .009).ConclusionsMalperfusion has a significant influence on early and late outcomes in ATAAD surgery. Management of preoperative malperfusion remains a major challenge in reducing mortality associated with surgical treatment of ATAAD.

【 授权许可】

Unknown