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

• Published in: The Journal of Thoracic and Cardiovascular Surgery
• Main Authors: Zindovic, Igor, Gudbjartsson, Tomas, Ahlsson, Anders, Fuglsang, Simon, Gunn, Jarmo, Hansson, Emma C, Hjortdal, Vibeke, Järvelä, Kati, Jeppsson, Anders, Mennander, Ari, Olsson, Christian, Pan, Emily, Sjögren, Johan, Wickbom, Anders, Geirsson, Arnar, Nozohoor, Shahab
• Other Authors: 1 Department of Clinical Sciences and Department of Cardiothoracic Surgery, Lund University, Skane University Hospital, Lund, Sweden. Electronic address: [e-mail]. 2 Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 3 Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital and School of Health and Medicine, Orebro University, Orebro, Sweden. 4 Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark. 5 Heart Center, Turku University Hospital and University of Turku, Turku, Finland. 6 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 7 Heart Center, Tampere University Hospital, Tampere, Finland. 8 Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden. 9 Department of Clinical Sciences and Department of Cardiothoracic Surgery, Lund University, Skane University Hospital, Lund, Sweden. 10 Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Mosby-Elsevier 2019
• Subjects: aorta; dissection; malperfusion; Slagæðargúlpur; Skurðlækningar; Postoperative Complications; Aneurysm; Dissecting; Iceland
• Online Access: http://hdl.handle.net/2336/620917; https://doi.org/10.1016/j.jtcvs.2018.10.134

To access publisher's full text version of this article click on the hyperlink below To 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. We 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. Preoperative 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). Malperfusion 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. University of Iceland Research Fund Landspitali Research Fund Mats Kleberg Foundation