Outcomes of surgically treated type a aortic dissection with malperfusion syndrome: an asian multi-institutional cohort study

Abstract Background : This study evaluated short- and long-term mortality in type A aortic dissection with malperfusion (mTAAD) and identified malperfusion types associated with short-term mortality. Method : We analyzed 1,021 patients with TAAD who underwent open surgery in Asia from 2002 to 2018, including 209 with preoperative malperfusion and 812 without. The primary outcome was surgical mortality; secondary outcomes were postoperative and postdischarge all-cause mortality. Outcomes were assessed using logistic regression and Cox proportional hazards models. Results : Surgical mortality was higher in the malperfusion group than in the nonmalperfusion group (28.7% vs. 15.8%; adjusted odds ratio [aOR], 1.93; 95% CI, 1.32–2.84). Postoperative all-cause mortality was also higher in patients with malperfusion (34.4% vs. 24.0%; aOR, 1.36; 95% CI, 1.01–1.83). Cerebral, renal, lower limb, and multiple-organ malperfusion were associated with increased surgical mortality (aOR = 2.27, 2.09, and 1.95 and 16.01, respectively; 95% confidence interval [CI] = 1.18–4.38, 1.11–3.93, 1.13–3.36, respectively). Among patients with single-organ malperfusion, only cerebral malperfusion remained significantly associated with surgical mortality (aOR, 2.25; 95% CI, 1.08–4.70). Conclusions : Patients with mTAAD are at high risk of short- and long-term mortality. Cerebral malperfusion is associated with high short-term mortality and could be incorporated into risk stratification models to improve the prediction of short-term mortality in patients undergoing surgery for TAAD.