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Ann Thorac Surg. 2014 Jul;98(1):59-64. doi: 10.1016/j.athoracsur.2014.03.026. Epub 2014 May 10.

Malperfusion syndrome without organ failure is not a risk factor for surgical procedures for type A aortic dissection.

Author information

  • 1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: kiick.sung@samsung.com.
  • 3Department of Medicine, Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND:

Malperfusion syndrome caused by acute type A aortic dissection is associated with high mortality. However, the impact of subclinical malperfusion is not clear. We reviewed surgical outcomes in acute type A dissection for the presence of clinical and subclinical malperfusion.

METHODS:

From 1998 to 2012 at Samsung Medical Center, 268 consecutive patients had an emergency operation for acute type A dissection. We divided patients into three groups: clinical, subclinical, and no malperfusion. Clinical malperfusion was identified by signs or symptoms of organ dysfunction (n=36). Subclinical malperfusion was defined as laboratory evidence of organ hypoperfusion or imaging findings without signs or symptoms (n=40). Patients with no evidence of malperfusion were defined as having no malperfusion (n=192).

RESULTS:

The mean patient age was 57.3±13.8 years, and 141 patients (53%) were women. Antegrade selective cerebral perfusion was used in 213 patients (79%). Total arch replacement was performed in 53 patients (20%). The average cardiopulmonary bypass time was 218.31±72.17 minutes. Early mortality was 8% in all patients, 5% in the no-malperfusion group, 8% in the subclinical malperfusion group, and 25% in the clinical malperfusion group. Overall survival in the clinical malperfusion group was worse than in the subclinical (p=0.026) and no-malperfusion (p<0.001) groups. Survival rates in the subclinical and no-malperfusion groups were not different (p=0.482). On multivariate Cox regression analysis, older age, longer cardiopulmonary bypass time, and clinical malperfusion syndrome were predictors of mortality.

CONCLUSIONS:

Mortality was not increased in asymptomatic patients with malperfusion by laboratory or imaging findings. Immediate operation before progression of organ malperfusion is still a valid option for patients with acute type A dissection.

Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

PMID:
24820387
[PubMed - indexed for MEDLINE]
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