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Malperfusion in acute type A aortic dissection: An update from the Nordic Consortium for Acute Type A Aortic Dissection
Department of Clinical Sciences and Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital and School of Health and Medicine, Örebro University, Örebro, Sweden.
Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark.
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2019 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 157, no 4, p. 1324-1333Article in journal (Refereed) Published
Abstract [en]

Objectives: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 157, no 4, p. 1324-1333
Keywords [en]
aorta, dissection, malperfusion
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
URN: urn:nbn:se:oru:diva-73494DOI: 10.1016/j.jtcvs.2018.10.134ISI: 000461717300047PubMedID: 30578066Scopus ID: 2-s2.0-85058500560OAI: oai:DiVA.org:oru-73494DiVA, id: diva2:1302334
Conference
Aortic Symposium of the American-Association-for-Thoracic-Surgery, New York, NY, USA, April 26-27, 2018
Note

Funding Agencies:

University of Iceland Research Fund  

Landspitali Research Fund  

Mats Kleberg Foundation 

Available from: 2019-04-04 Created: 2019-04-04 Last updated: 2019-04-04Bibliographically approved

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