Malperfusion Syndrome in Patients with Acute Type A Aortic Dissection: Incidence and Mortality Rates after Surgical Repair

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All articles of this category (opens in new window) Background: Organ malperfusion is a well-known complication of acute Type A aortic dissection jeopardizing outcome after surgical repair. In this multicenter study we report rates of malperfusion syndrome according to the Penn classification and mortality in a large cohort of patients after surgical repair. Methods: Data on organ malperfusion syndrome were retrieved form the multicenter European Registry of Type A Aortic Dissection (ERTAAD) including 18 participating European centers. Malperfusion was classified according to the Penn classification. Results: A total of 3.902 consecutive patients underwent repair for Acute Type A Aortic Dissection, of whom 1780 (45.62%) presented with signs of preoperative malperfusion. Local malperfusion syndrome occurred in 1584 (40.58%) patients. Involvement of more than one organ occurred in 582 patients (36.74%) whereas 1002 patients (63.26%) had single organ malperfusion. The most frequent was the cerebral malperfusion (21.27%) followed by peripheral malperfusion (13.94%), myocardial (9.7%), renal (9.33%), mesenteric (4.15%) and spinal malperfusion (2.10%). In total of 687 (17.6%) global malperfusion (Penn C) was present whereas combination of local and general malperfusion occurred in 424 (10.86%) patients (Penn BC). Rates of in-hospital mortality increased with the severity of malperfusion as shown by the Penn classification: Penn A 12.38% (absence of any malperfusion); Penn B 20.71% (local malperfusion) ( p < 0.0001 OR 1.878 CI 1.58 to 2.25) ; Penn C 28.90% (global malperfusion) ( p < 0.0001 OR 2.64 CI 1.98 to 3.51); Penn B-C (combination of local and global malperfusion) 31.84% ( p < 0.0001 OR. 3.15 CI 2.51 to 3.97). Conclusion: Almost half of the cohort presents with signs of malperfusion syndrome mostly due to local involvement. More than one-third of patients with local malperfusion syndrome have multivessel involvement. Different levels of Penn classification can be used as valid predictors of mortality. Publication History Article published online: 13 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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