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Early Aortic Repair In Acute Type A Aortic Dissection Complicated With Malperfusion
Kan-paatib BARNABO NAMPOUKIME, hai hao Wang;
Tongji Hospital, Huazhong University of Science and Technology, wuhan, China
BACKGROUND:This study aimed to investigate clinical characteristics, surgical outcomes, and management strategies for early aortic repair in patients with acute Type A aortic dissection (ATAAD) complicated by malperfusion syndrome.
METHODS:Between January 2021 and December 2022, we evaluated 565 patients diagnosed with Type A aortic dissection, excluding 73 patients due to various reasons. Of the remaining, 328 received surgical interventions within 24 hours of admission. The study cohort was categorized based on the presence of malperfusion. Clinical data, operative details, and postoperative outcomes were analyzed.
RESULTS:Malperfusion was observed in 30.80% of the study cohort. Hospital mortality rates were 18.9% for patients without malperfusion and 24.8% for those with malperfusion. Post-early aortic repair, mortality rates: Cerebral malperfusion (17 patients) 23.5%, visceral (37) 18.9%, Kidney malperfusion (9 patients) 11.1%, limb malperfusion (8 patients) no deaths reported. Cardiac (35) 28.57%, more than two organs (26 patients) 42.30% mortality. In malperfused patients, longer cardiopulmonary bypass time, extended hospital stay, elevated preoperative lactic acid levels, visceral malperfusion, malperfusion in multiple organs, and postoperative multiple organ dysfunction syndrome were independent predictors of hospital mortality.
CONCLUSIONS:Cerebral malperfusion, cardiac malperfusion, and multi-organ malperfusion were associated with poor outcomes, and central repair demonstrated limited effectiveness in addressing these severe and complex malperfusion cases. The debate surrounding early reperfusion strategies and central aortic repair holds promise for improving outcomes in these critically ill patients.
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