Single-Center Multidisciplinary Experience with Type A Dissections with Malperfusion

BACKGROUND: Malperfusion of the viscera and/or lower extremities in type A aortic dissection carries high morbidity and mortality. However, risk factors associated with organ or limb malperfusion are not well understood. We evaluated these risk factors in a population of patients who developed malperfusion in the setting of an acute type A dissection and reviewed the surgical interventions performed. METHODS: A retrospective analysis was conducted on 178 patients with acute type A aortic dissection at a single quaternary care center from 2017 to 2023. Data collection included demographics, aortic dissection anatomy, peripheral neurovascular exam, surgical repair, and postoperative survival and limb outcomes. Limb malperfusion was defined as pulse deficit, sensory loss/pain, or motor loss in one or both limbs. Visceral malperfusion was defined as any ischemia of the intraabdominal viscera informed by radiographic evidence. RESULTS: Patients in our cohorts were predominantly male (n= 118; 66%) with comorbidities of a typical cardiovascular cohort. Malperfusion of any type occurred in n= 36 (20%) patients; n= 16 (9.0%) underwent fasciotomies, n= 8 underwent extra-anatomic bypasses, and 1 underwent major amputation. Twenty-two (64.7%) cases of malperfusion were alleviated with type A repair alone. Malperfusion was associated with distal dissection zone (P< 0.001) and higher lactate at presentation (P= 0.02). CONCLUSION: We present a large single-center retrospective analysis of type A aortic dissection and vascular interventions for malperfusion. Distal dissection zone and lactate were associated with malperfusion. Early mortality was similar between patients with malperfusion who did or did not receive additional vascular surgery intervention.