Abstract
Introduction
To determine the timing of operation might be the most important factors for surgical outcomes of acute type A aortic dissection (AADA), we analyzed our experience managing AADA complicated by malperfusion syndrome.
Method
Between 11/10 and 2/19, 184 patients with AADA were treated surgically, including 60 patients (32.6%) presented with malperfusion. The mean age of the patients was 71.3±13.3 and female was 94 (51.1%). Prevalences of malperfusions of brain, coronary, kidney, intestine, and extremities were 30 (16.3%), 16 (8.7%), 6 (3.3%), 3 (1.6%), and 23 (12.5%), respectively. Eighty-nine patients (48.4%) were repaired within 6 hours from onset of symptoms and 95 (51.6%) repaired after 6 hours from onset. Aortic repair included total arch replacement in 69 (37.5%) patients and hemiarch in 115 (62.5%). Effect of immediate aortic repair (within 6 hours from onset) and malperfusion syndromes on surgical outcomes of the patients were analyzed.
Results
Overall 30-days-survival rate after aortic repair for AADA was 93.5% (172/184). Early mortality after repairs with malperfusion was 13.3% (8/60): 11.9% (5/42) with immediate repair, and 16.7% (3/18) repaired after 6 hours from onset (late repair). Early mortality after repairs without malperfusion was 3.2% (4/124): 2.3% (1/44) with immediate repair, and 3.8% (3/80) with late repair. Early mortality after repairs with malperfusion was significantly higher than that without malperfusion. In each groups including 184 patients after aortic repair for AADA, 60 patients with malperfusion and 124 patients without malperfusion, there was no significant difference in early mortality rate between immediate repair group and late group.
Conclusion
Malperfusion syndrome was independent risk factor for aortic repairs of acute type-A aortic dissection, and time from onset to operation was not directly related to better outcomes in this patient cohort.
Surgical outcomes of aortic repair via transapical cannulation and the adventitial inversion technique for acute Type A aortic dissection†
