Management of malperfusion: New York approach and outcomes. Issue 5 (19th September 2020)
- Record Type:
- Journal Article
- Title:
- Management of malperfusion: New York approach and outcomes. Issue 5 (19th September 2020)
- Main Title:
- Management of malperfusion: New York approach and outcomes
- Authors:
- Iannacone, Erin
Robinson, Bryce
Rahouma, Mohamed
Girardi, Leonard - Other Names:
- Bashir Mohamad guestEditor.
Bavaria Joseph guestEditor.
Elefteriades John guestEditor.
Chen Ed guestEditor. - Abstract:
- Abstract: Background and Aim: Aortic branch malperfusion complicates up to one‐third of acute type A aortic dissection (ATAAD), and it is a strong predictor of poor outcomes. We analyzed our results for the surgical management of this high‐risk cohort. Methods: We queried our aortic database for consecutive patients undergoing ATAAD repair. Those presenting with malperfusion were compared with those without. Outcomes were compared using univariate and multivariate analysis. Results: From 1997 to 2019, a total of 336 patients underwent ATAAD repair. A total of 97 ATAAD patients presented with malperfusion. Malperfusion patients were more likely to be male (54.8% vs. 75.3%; p = .001), have had a prior myocardial infarction (11.9% vs. 26.8%; p = .001), to present with preoperative renal dysfunction (22.2% vs. 54.6%; p < .001), and to present with shock (12.6% vs. 28.9%; p = .001). The malperfusion group more often underwent coronary artery bypass grafting (5.4% vs. 24.7%; p < .001), and required additional noncardiac procedures 10.3% of the time. Operative mortality (0.8% vs. 15.5%; p < .001) and major adverse events (MAEs) (7.6% vs. 20.6%; p = .001) were both greater for the malperfusion patients. Ejection fraction, diabetes, and malperfusion were predictors of MAEs. Cerebral, coronary, mesenteric, and multiple vascular bed malperfusion were predictors of MAEs, while extremity, renal, and spinal were not. Conclusion: Improving outcomes for this high‐risk cohort requiresAbstract: Background and Aim: Aortic branch malperfusion complicates up to one‐third of acute type A aortic dissection (ATAAD), and it is a strong predictor of poor outcomes. We analyzed our results for the surgical management of this high‐risk cohort. Methods: We queried our aortic database for consecutive patients undergoing ATAAD repair. Those presenting with malperfusion were compared with those without. Outcomes were compared using univariate and multivariate analysis. Results: From 1997 to 2019, a total of 336 patients underwent ATAAD repair. A total of 97 ATAAD patients presented with malperfusion. Malperfusion patients were more likely to be male (54.8% vs. 75.3%; p = .001), have had a prior myocardial infarction (11.9% vs. 26.8%; p = .001), to present with preoperative renal dysfunction (22.2% vs. 54.6%; p < .001), and to present with shock (12.6% vs. 28.9%; p = .001). The malperfusion group more often underwent coronary artery bypass grafting (5.4% vs. 24.7%; p < .001), and required additional noncardiac procedures 10.3% of the time. Operative mortality (0.8% vs. 15.5%; p < .001) and major adverse events (MAEs) (7.6% vs. 20.6%; p = .001) were both greater for the malperfusion patients. Ejection fraction, diabetes, and malperfusion were predictors of MAEs. Cerebral, coronary, mesenteric, and multiple vascular bed malperfusion were predictors of MAEs, while extremity, renal, and spinal were not. Conclusion: Improving outcomes for this high‐risk cohort requires rapid diagnosis and reversal of ischemia while minimizing the risk of aortic rupture, irrespective of the strategic approach. … (more)
- Is Part Of:
- Journal of cardiac surgery. Volume 36:Issue 5(2021)
- Journal:
- Journal of cardiac surgery
- Issue:
- Volume 36:Issue 5(2021)
- Issue Display:
- Volume 36, Issue 5 (2021)
- Year:
- 2021
- Volume:
- 36
- Issue:
- 5
- Issue Sort Value:
- 2021-0036-0005-0000
- Page Start:
- 1757
- Page End:
- 1765
- Publication Date:
- 2020-09-19
- Subjects:
- aorta and great vessels -- aortic aneurysm -- aortic repair -- malperfusion syndrome -- type A dissection
Heart -- Surgery -- Periodicals
617.412005 - Journal URLs:
- http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1540-8191 ↗
http://www.blackwell-synergy.com/rd.asp?goto=journal&code=jcs ↗
http://onlinelibrary.wiley.com/ ↗
http://firstsearch.oclc.org ↗ - DOI:
- 10.1111/jocs.15025 ↗
- Languages:
- English
- ISSNs:
- 0886-0440
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 4954.863500
British Library DSC - BLDSS-3PM
British Library HMNTS - ELD Digital store - Ingest File:
- 22902.xml