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In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion

Paolo Nardi, Dionisio F. Colella, Marco Russo, Guglielmo Saitto, Antonio Scafuri, Carlo Bassano, Antonio Pellegrino, Giovanni Ruvolo.

Abstract
Aims: To evaluate the effect of postoperative malperfusion (PM) on operative mortality and on late survival in patients who underwent surgery for acute type A aortic dissection in a referred center for aortic emergency surgery.
Patients and Methods: From January 2005 to September 2015, 237 patients were referred for aortic emergency surgery at our center. We examined complete data available on 214 patients (mean age 62.5▒12.6 years, 156 males). At presentation, various types of preoperative malperfusion (cerebral, renal, mesenteric) were observed in 119 patients (55.6%). Arterial access for cardiopulmonary bypass was via femoral artery (n = 99), via axillary artery (n = 99), or into the ascending aorta (n = 22). Aortic repair was performed using an open technique in 124 patients (58%).
Results: Fifty-five patients (25.7%) presented PM; operative mortality was 29% (62/214): 47.3% in PM patients vs. 22.6% in non-PM patients (P < 0.0001). Independent predictors were age >75 years at the time of operation (OR: 1.1, P = 0.0004) and renal PM (OR: 53.5, P = 0.0027). Five-year survival was 79▒7% in PM vs. 94▒3% in non-PM patients (P = 0.002). Independent predictors for reduced survival were age >75 years (OR: 375, P = 0.05) and renal PM (OR: 28.6, P = 0.01). All types of PM and the location of intimal tear distal to the ascending aorta were found as risk factors for survival in the univariate analysis only (P < 0.05).
Conclusions: Surgery for acute aortic dissection is effective in reducing preoperative malperfusion by about 50%. Renal PM is associated with higher operative mortality, whereas all types of PM, in particular renal PM, negatively affected late survival. Surgical techniques, site of arterial cannulation, and more complex interventions requiring an open technique did not appear to be predictors of increased risk.

Key words: Type A acute aortic dissection, aortic surgery, preoperative malperfusion, postoperative malperfusion

 

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Pubmed Style

Nardi P, Colella DF, Russo M, Saitto G, Scafuri A, Bassano C, Pellegrino A, Ruvolo G. In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. doi:10.5455/aces.20160816012549


Web Style

Nardi P, Colella DF, Russo M, Saitto G, Scafuri A, Bassano C, Pellegrino A, Ruvolo G. In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. www.scopemed.org/?mno=225057 [Access: September 20, 2017]. doi:10.5455/aces.20160816012549


AMA (American Medical Association) Style

Nardi P, Colella DF, Russo M, Saitto G, Scafuri A, Bassano C, Pellegrino A, Ruvolo G. In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. doi:10.5455/aces.20160816012549


Vancouver/ICMJE Style

Nardi P, Colella DF, Russo M, Saitto G, Scafuri A, Bassano C, Pellegrino A, Ruvolo G. In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. doi:10.5455/aces.20160816012549


Harvard Style

Nardi, P., Colella, D. F., Russo, M., Saitto, G., Scafuri, A., Bassano, C., Pellegrino, A. & Ruvolo, G. (2017) In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. doi:10.5455/aces.20160816012549


Turabian Style

Nardi, Paolo, Dionisio F. Colella, Marco Russo, Guglielmo Saitto, Antonio Scafuri, Carlo Bassano, Antonio Pellegrino, and Giovanni Ruvolo. 2017. In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. doi:10.5455/aces.20160816012549


Chicago Style

Nardi, Paolo, Dionisio F. Colella, Marco Russo, Guglielmo Saitto, Antonio Scafuri, Carlo Bassano, Antonio Pellegrino, and Giovanni Ruvolo. “In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion.” doi:10.5455/aces.20160816012549


MLA (The Modern Language Association) Style

Nardi, Paolo, Dionisio F. Colella, Marco Russo, Guglielmo Saitto, Antonio Scafuri, Carlo Bassano, Antonio Pellegrino, and Giovanni Ruvolo. “In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion.” doi:10.5455/aces.20160816012549


APA (American Psychological Association) Style

Nardi, P., Colella, D. F., Russo, M., Saitto, G., Scafuri, A., Bassano, C., Pellegrino, A. & Ruvolo, G. (2017) In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. doi:10.5455/aces.20160816012549