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
Articolo
Data di Pubblicazione:
2013
Citazione:
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 / M. Di Eusanio, S. Trimarchi, H.J. Patel, S. Hutchison, T. Suzuki, M.D. Peterson, R. Di Bartolomeo, G. Folesani, R.E. Pyeritz, A.C. Braverman, D.G. Montgomery, E.M. Isselbacher, C.A. Nienaber, K.A. Eagle, R. Fattori. - In: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 0022-5223. - 145:2(2013 Feb), pp. 385-390.
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.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Acute Disease; Adult; Aged; Aneurysm, Dissecting; Aortic Aneurysm; Chi-Square Distribution; Europe; Female; Hospital Mortality; Humans; Ischemia; Japan; Logistic Models; Male; Mesenteric Ischemia; Middle Aged; Multivariate Analysis; North America; Odds Ratio; Postoperative Complications; Registries; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Diseases; Endovascular Procedures; Splanchnic Circulation; Vascular Surgical Procedures; Cardiology and Cardiovascular Medicine; Surgery; Pulmonary and Respiratory Medicine
Elenco autori:
M. Di Eusanio, S. Trimarchi, H.J. Patel, S. Hutchison, T. Suzuki, M.D. Peterson, R. Di Bartolomeo, G. Folesani, R.E. Pyeritz, A.C. Braverman, D.G. Montgomery, E.M. Isselbacher, C.A. Nienaber, K.A. Eagle, R. Fattori
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