Malperfusion in Acute Type A Aortic Dissection: Management Strategies

Over the decades, it has been well established that malperfusion complicates a number of acute type A aortic dissection (ATAAD) patients. Of the many complications that arise from ATAAD is malperfusion, which is the result of true lumen compression secondary to the dissection, and it is one of the most dangerous complications. Left untreated, malperfusion can eventually compromise circulation to the vascular beds of almost all vital organs. Clinicians must consider the diagnosis of malperfusion promptly following a diagnosis of acute aortic dissection. The outcomes post-surgery for patients with ATAAD with concomitant malperfusion remains poor, despite mortality for aortic surgery improving over time. Optimal management for ATAAD with associated malperfusion has yet to be implemented, further research is warranted to improve the detection and management of this potentially fatal pathology. In this review, we explore the literature surrounding the complications of malperfusion in ATAAD and the various symptom presentations, investigations, and management strategies available.

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Acute Type A Aortic Dissection with Cardiac Tamponade: Unexpected Late Survival without Aortic Surgery

Journal of Cardiac Surgery ◽

10.1111/jocs.12369 ◽

2014 ◽

Vol 29 (4) ◽

pp. 529-530

Author(s):

Katie Jerzewski ◽

Alexander Kulik

Keyword(s):

Aortic Dissection ◽

Cardiac Tamponade ◽

Aortic Surgery ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Late Survival

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Hybrid Strategy for Residual Arch and Thoracic Aortic Dissection following Acute Type A Aortic Dissection Repair

Case Reports in Vascular Medicine ◽

10.1155/2014/165425 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Sidharth Viswanathan ◽

Vivek Agrawal ◽

Shashidhar Kallappa Parameshwarappa ◽

Ajay Savlania ◽

Santhosh Kumar ◽

...

Keyword(s):

Aortic Dissection ◽

Circulatory Arrest ◽

Management Strategies ◽

False Lumen ◽

Type A ◽

High Morbidity ◽

Acute Type ◽

Hybrid Strategy ◽

Type A Aortic Dissection ◽

Thoracic Aortic Dissection

Progressive dilatation of the false lumen in the arch and descending aorta has been encountered in one-third of survivors as a late sequelae following repair of ascending aortic dissection. Conventional treatment for the same requiring cardiopulmonary bypass and deep hypothermic circulatory arrest is associated with high morbidity and mortality especially in the elderly cohort of patients. Herein we report a case of symptomatic progressive aneurysmal dilatation of residual arch and descending thoracic aortic dissection following repair of type A aortic dissection, successfully treated by total arch debranching and ascending aortic prosthesis to bicarotid and left subclavian bypass followed by staged retrograde aortic stent-graft deployment. This case report with relevant review of the literature highlights this clinical entity and the present evidence on its appropriate management strategies. Close surveillance is mandatory following surgical repair of type A aortic dissection and hybrid endovascular procedures seem to be the most dependable modality for salvage of patients detected to have progression of residual arch dissection.

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A Case of Loeys-Dietz Syndrome That Caused Rapid Enlargement of the Distal Aortic Arch Following Aortic Surgery for Acute Type A Aortic Dissection

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.41.316 ◽

2012 ◽

Vol 41 (6) ◽

pp. 316-319

Author(s):

Takashi Yoshinaga ◽

Ryuji Kunitomo ◽

Shuji Moriyama ◽

Ken Okamoto ◽

Hisashi Sakaguchi ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Aortic Surgery ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Rapid Enlargement

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A Case of Heparin-Induced Thrombocytopenia (HIT) following Aortic Surgery for Acute Type A Aortic Dissection

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.35.222 ◽

2006 ◽

Vol 35 (4) ◽

pp. 222-225 ◽

Cited By ~ 1

Author(s):

Masayoshi Katsumata ◽

Yoshiharu Takahara ◽

Kenji Mogi ◽

Atsushi Tamura

Keyword(s):

Aortic Dissection ◽

Aortic Surgery ◽

Type A ◽

Acute Type ◽

Heparin Induced Thrombocytopenia ◽

Type A Aortic Dissection

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Operative Strategies and Outcomes in Type a Aortic Dissection after the Enactment of a Multidisciplinary Aortic Surgery Team

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000212 ◽

2015 ◽

Vol 10 (6) ◽

pp. 410-415 ◽

Cited By ~ 7

Author(s):

Jared P. Beller ◽

Joshua A. Scheinerman ◽

Leora B. Balsam ◽

Patricia Ursomanno ◽

Abe DeAnda

Keyword(s):

Aortic Dissection ◽

Patient Outcomes ◽

Acute Aortic Dissection ◽

Operative Mortality ◽

Aortic Surgery ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

International Registry ◽

Operative Strategies

Objective The purpose of this study was to compare operative strategies and patient outcomes in acute type A aortic dissection (ATAAD) repairs before and after the implementation of a multi-disciplinary aortic surgery team. Methods Between May 2005 and July 2014, 101 patients underwent ATAAD repair at our institution. A dedicated multidisciplinary aortic surgery team (experienced aortic surgeon, perfusionists, cardiac anesthesiologists, nurses, and radiologists) was formed in 2010. We retrospectively compared ATAAD repair outcomes in patients before (2005–2009, N = 39) and after (2010–2014, N = 62) implementation of our program. Expected operative mortality was calculated using the International Registry of Acute Aortic Dissection preoperative predictive model. Results This study demonstrated a significant reduction in operative mortality after implementation of the aortic surgery program (30.8% vs. 9.7%; P = 0.014). There was also an increase in the complexity of surgical technique and perfusion strategies with fewer postoperative complications related to respiratory (P < 0.0001) and renal failure (P = 0.034). Baseline demographics were similar, and there was no statistically significant difference in International Registry of Acute Aortic Dissection predictive variables between the 2 groups. However, there was a 3.5-fold reduction in the observed-to-expected (O/E) operative mortality ratio. There was a 50% increase in volume with a significant number of patients being admitted directly to our aortic center for ATAAD repair, thus avoiding delay in operation related to transfers from a secondary hospital. Conclusions Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.

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Basic Approaches for the Surgical Management of Acute Type A Aortic Dissection: Safe Management Strategies for the General Cardiac Surgeon

10.1007/978-3-030-66668-2_20 ◽

2021 ◽

pp. 283-292

Author(s):

Tirone E. David

Keyword(s):

Aortic Dissection ◽

Surgical Management ◽

Management Strategies ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Safe Management ◽

Cardiac Surgeon ◽

Basic Approaches

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Rapid Diagnosis and Treatment of Patients with Acute Type A Aortic Dissection and Malperfusion Syndrome May Normalize Survival to that of Patients with Uncomplicated Type A Aortic Dissection

Aorta ◽

10.1055/s-0039-1691790 ◽

2019 ◽

Vol 07 (02) ◽

pp. 042-048 ◽

Cited By ~ 1

Author(s):

Syed Usman Bin Mahmood ◽

Makoto Mori ◽

Jiajun Luo ◽

Yawei Zhang ◽

Basmah Safdar ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Surgery ◽

Type A ◽

Multivariate Regression Analysis ◽

Acute Type ◽

Type A Aortic Dissection ◽

Acute Type A Dissection ◽

Operative Outcomes ◽

Nonsignificant Difference ◽

Malperfusion Syndrome

Objectives Malperfusion syndrome in the setting of acute Type A dissection (ATAD) is typically associated with poor prognosis. We evaluated the contemporary outcomes of patients with ATAD presenting with and without malperfusion syndrome who underwent aortic surgery. Methods We performed a single-center, retrospective review of 103 consecutive patients that underwent surgery for ATAD. The cohort was dichotomized by patients with and without malperfusion syndromes. Multivariate and bivariate analyses were performed to evaluate association between the presence of malperfusion syndrome and operative outcomes. Results A total of 29 (28.1%) patients presented with malperfusion syndrome. The 30-day mortality for patients presenting with and without malperfusion was 13.7 and 9.4%, respectively (p = 0.49). Patients with malperfusion syndrome had a shorter mean admission-to-incision interval of 4.3 ± 2.5 hours compared with 6.3 ± 4.6 hours for those without malperfusion (p = 0.02). Difference in 30-day mortality for patients with and without malperfusion syndrome was found to be nonsignificant on multivariate regression analysis (odds ratio: 1.53; 95% confidence interval: 0.40–5.82, p = 0.49). Conclusions This series demonstrated that there was nonsignificant difference in early- or midterm outcomes for patients with and without malperfusion syndrome. Patients with malperfusion were taken to the operating room more rapidly than those without, which offers a potential explanation for the comparable outcome of the malperfusion cohort.

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