1. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection.
- Author
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Di Eusanio M, Trimarchi S, Patel HJ, Hutchison S, Suzuki T, Peterson MD, Di Bartolomeo R, Folesani G, Pyeritz RE, Braverman AC, Montgomery DG, Isselbacher EM, Nienaber CA, Eagle KA, and Fattori R
- Subjects
- Acute Disease, Adult, Aged, Aortic Dissection complications, Aortic Dissection diagnosis, Aortic Dissection mortality, Aortic Dissection physiopathology, Aortic Aneurysm complications, Aortic Aneurysm diagnosis, Aortic Aneurysm mortality, Aortic Aneurysm physiopathology, Chi-Square Distribution, Europe, Female, Hospital Mortality, Humans, Ischemia complications, Ischemia diagnosis, Ischemia mortality, Ischemia physiopathology, Japan, Logistic Models, Male, Mesenteric Ischemia, Middle Aged, Multivariate Analysis, North America, Odds Ratio, Postoperative Complications mortality, Postoperative Complications therapy, Registries, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Vascular Diseases complications, Vascular Diseases diagnosis, Vascular Diseases mortality, Vascular Diseases physiopathology, Aortic Dissection surgery, Aortic Aneurysm surgery, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Ischemia surgery, Splanchnic Circulation, Vascular Diseases surgery, Vascular Surgical Procedures adverse effects, Vascular Surgical Procedures mortality
- Abstract
Background: Few data exist on clinical/imaging characteristics, management, and outcomes of patients with type A acute dissection and mesenteric malperfusion., Methods: Patients with type A acute dissection enrolled in the International Registry for Acute Dissection (IRAD) were evaluated to assess differences in clinical features, management, and in-hospital outcomes according to the presence/absence of mesenteric malperfusion. A mortality model was used to identify predictors of in-hospital mortality in patients with mesenteric malperfusion., Results: Mesenteric malperfusion was detected in 68 (3.7%) of 1809 patients with type A acute dissection. Patients with mesenteric malperfusion were more likely to be older and to have coma, cerebrovascular accident, spinal cord ischemia, acute renal failure, limb ischemia, and any pulse deficit. They were less likely to undergo surgical/hybrid treatment (52.9% vs 87.9%) and more likely to receive only medical (30.9% vs 11.6%) or endovascular (16.2% vs 0.5%) management (P < .001). Overall in-hospital mortality was 63.2% and 23.8% in patients with and without mesenteric malperfusion, respectively (P < .001). In-hospital mortality of patients with mesenteric malperfusion receiving medical, endovascular, and surgical/hybrid therapy was 95.2%, 72.7%, and 41.7%, respectively (P < .001). At multivariate analysis, male gender (odds ratio [OR], 1.7; P = .002), age (OR, 1.1/y; P = .002), and renal failure (OR, 5.9; P = .020) were predictors of mortality whereas surgical/hybrid management (OR, 0.1; P = .005) was associated with better outcome., Conclusions: Type A acute aortic dissection complicated by mesenteric malperfusion is a rare but ominous complication carrying a high risk of hospital mortality. Surgical/hybrid therapy, although associated with 2-fold hospital mortality, appears to be associated with better long-term outcomes in the management of type A acute aortic dissection in this setting., (Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2013
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