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Nardi et al. Vessel Plus 2017;1:77-83 Vessel Plus
DOI: 10.20517/2574-1209.2017.07
www.vpjournal.net
Original Article Open Access

The effect of postoperative malperfusion

after surgical treatment of type A acute aortic

dissection on early and mid-term survival

Paolo Nardi¹, Carlo Olevano², Carlo Bassano¹, Emanuele Bovio¹, Lorenzo Cecchetti¹, Stefano Forlani², Giovanni
Ruvolo¹

1 Department of Cardiac Surgery, Tor Vergata University Policlinic, 00133 Rome, Italy.
2 Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield S5 7AU, UK.

Correspondence to: Dr. Paolo Nardi, Cardiac Surgery Unit, Tor Vergata University Policlinic, Viale Oxford 81, 00133 Rome, Italy.
E-mail: pa.nardi4@libero.it
How to cite this article: Nardi P, Olevano C, Bassano C, Bovio E, Cecchetti L, Forlani S, Ruvolo G. The effect of postoperative malperfusion after surgical
treatment of type A acute aortic dissection on early and mid-term survival. Vessel Plus 2017;1:77-83.
ABSTRACT
Article history: Aim: To evaluate whether postoperative malperfusion (PM) affected in-hospital and long-
Received: 06-03-2017 term survival in acute type A aortic dissection (AAAD) surgical patients and to identify
Accepted: 06-04-2017 risk factors for PM. Methods: Patients who underwent AAAD surgery at a single institution
Published: 27-06-2017 between January 2005 and March 2015 were retrospectively analyzed. Results: Two-
hundred fourteen patients with complete data were identified. At presentation, 119 patients
(55.6%) showed preoperative malperfusions: 68 (31.8%) were cerebral, 38 (17.7%) were renal,
Key words: and 13 (6.1%) were mesenteric. PM was found in 55 patients (25.7%). In-hospital mortality
Acute type aortic dissection, was 47.3% (26/55) vs. 22.6% (36/159) in PM and non-PM patients, respectively (P < 0.0001).
aortic surgery, Independent predictors for in-hospital mortality included being 75 years or older [odds ratio
malperfusion, (OR): 1.1, 95% confidence interval (CI): 1.03-1.13, P < 0.001] and having renal PM (OR: 53.5,
survival
95% CI: 3.97-721.3, P < 0.01). Five-year survival was 78.6 ± 7.8% vs. 93.9 ± 3.4% in PM and
non-PM patients, respectively (P < 0.001). Independent predictors for long-term survival
were being at least 75 years old (OR: 3.7, 95% CI: 0.9-14.0, P = 0.05) and having renal
PM (OR: 28.6, 95% CI: 1.8-462.0, P = 0.01). PM and intimal tears distal to the ascending
aorta or the proximal aortic arch were also risk factors. Conclusion: PM, especially with
renal involvement, is associated with in-hospital mortality and reduced long-term survival.
AAAD surgeries reduced preoperative malperfusions. Sites of cannulation and interventions
requiring circulatory arrest during cardiopulmonary bypass were not predictors of PM.

INTRODUCTION referrals for patients, preoperative care and improved
surgical techniques, in-hospital mortality following
Acute type A aortic dissection (AAAD) is a life- surgery remains high, ranging from 10% to 30%. [1,2]
threatening condition and one of the most challenging
diseases faced by cardiothoracic surgeons. Despite Malperfusion of systemic organs is a complication
preventative measures including early surgical of aortic dissection caused by branch-vessel
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