Malperfusion in acute type A aortic dissection: An update from the Nordic Consortium for Acute Type A Aortic Dissection
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Malperfusion in acute type A aortic dissection : An update from the Nordic Consortium for Acute Type A Aortic Dissection. / Zindovic, Igor; Gudbjartsson, Tomas; Ahlsson, Anders; Fuglsang, Simon; Gunn, Jarmo; Hansson, Emma C; Hjortdal, Vibeke; Järvelä, Kati; Jeppsson, Anders; Mennander, Ari; Olsson, Christian; Pan, Emily; Sjögren, Johan; Wickbom, Anders; Geirsson, Arnar; Nozohoor, Shahab.
In: The Journal of Thoracic and Cardiovascular Surgery, Vol. 157, No. 4, 04.2019, p. 1324-1333.e6.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Malperfusion in acute type A aortic dissection
T2 - An update from the Nordic Consortium for Acute Type A Aortic Dissection
AU - Zindovic, Igor
AU - Gudbjartsson, Tomas
AU - Ahlsson, Anders
AU - Fuglsang, Simon
AU - Gunn, Jarmo
AU - Hansson, Emma C
AU - Hjortdal, Vibeke
AU - Järvelä, Kati
AU - Jeppsson, Anders
AU - Mennander, Ari
AU - Olsson, Christian
AU - Pan, Emily
AU - Sjögren, Johan
AU - Wickbom, Anders
AU - Geirsson, Arnar
AU - Nozohoor, Shahab
N1 - Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2019/4
Y1 - 2019/4
N2 - OBJECTIVES: To evaluate the effect of preoperative malperfusion on 30-day and late mortality and postoperative complications using data from the Nordic Consortium for Acute Type A Aortic Dissection (ATAAD) registry.METHODS: We studied 1159 patients who underwent ATAAD surgery between January 2005 and December 2014 at 8 Nordic centers. Multivariable logistic and Cox regression analyses were performed to identify independent predictors of 30-day and late mortality.RESULTS: Preoperative malperfusion was identified in 381 of 1159 patients (33%) who underwent ATAAD surgery. Thirty-day mortality was 28.9% in patients with preoperative malperfusion and 12.1% in those without. Independent predictors of 30-day mortality included any malperfusion (odds ratio, 2.76; 95% confidence interval [CI], 1.94-3.93), cardiac malperfusion (odds ratio, 2.37; 95% CI, 1.34-4.17), renal malperfusion (odds ratio, 2.38; 95% CI, 1.23-4.61) and peripheral malperfusion (odds ratio, 1.95; 95% CI, 1.26-3.01). Any malperfusion (hazard ratio, 1.72; 95% CI, 1.21-2.43), cardiac malperfusion (hazard ratio, 1.89; 95% CI, 1.24-2.87) and gastrointestinal malperfusion (hazard ratio, 2.25; 95% CI, 1.18-4.26) were predictors of late mortality. Malperfusion was associated with significantly poorer survival at 1, 3, and 5 years (95.0% ± 0.9% vs 88.7% ± 1.9%, 90.1% ± 1.3% vs 84.0% ± 2.4%, and 85.4% ± 1.7% vs 80.8% ± 2.7%; log rank P = .009).CONCLUSIONS: Malperfusion has a significant influence on early and late outcomes in ATAAD surgery. Management of preoperative malperfusion remains a major challenge in reducing mortality associated with surgical treatment of ATAAD.
AB - OBJECTIVES: To evaluate the effect of preoperative malperfusion on 30-day and late mortality and postoperative complications using data from the Nordic Consortium for Acute Type A Aortic Dissection (ATAAD) registry.METHODS: We studied 1159 patients who underwent ATAAD surgery between January 2005 and December 2014 at 8 Nordic centers. Multivariable logistic and Cox regression analyses were performed to identify independent predictors of 30-day and late mortality.RESULTS: Preoperative malperfusion was identified in 381 of 1159 patients (33%) who underwent ATAAD surgery. Thirty-day mortality was 28.9% in patients with preoperative malperfusion and 12.1% in those without. Independent predictors of 30-day mortality included any malperfusion (odds ratio, 2.76; 95% confidence interval [CI], 1.94-3.93), cardiac malperfusion (odds ratio, 2.37; 95% CI, 1.34-4.17), renal malperfusion (odds ratio, 2.38; 95% CI, 1.23-4.61) and peripheral malperfusion (odds ratio, 1.95; 95% CI, 1.26-3.01). Any malperfusion (hazard ratio, 1.72; 95% CI, 1.21-2.43), cardiac malperfusion (hazard ratio, 1.89; 95% CI, 1.24-2.87) and gastrointestinal malperfusion (hazard ratio, 2.25; 95% CI, 1.18-4.26) were predictors of late mortality. Malperfusion was associated with significantly poorer survival at 1, 3, and 5 years (95.0% ± 0.9% vs 88.7% ± 1.9%, 90.1% ± 1.3% vs 84.0% ± 2.4%, and 85.4% ± 1.7% vs 80.8% ± 2.7%; log rank P = .009).CONCLUSIONS: Malperfusion has a significant influence on early and late outcomes in ATAAD surgery. Management of preoperative malperfusion remains a major challenge in reducing mortality associated with surgical treatment of ATAAD.
KW - Acute Disease
KW - Aged
KW - Aneurysm, Dissecting/diagnostic imaging
KW - Aortic Aneurysm/diagnostic imaging
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Regional Blood Flow
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Scandinavian and Nordic Countries
KW - Time Factors
KW - Treatment Outcome
KW - Vascular Surgical Procedures/adverse effects
U2 - 10.1016/j.jtcvs.2018.10.134
DO - 10.1016/j.jtcvs.2018.10.134
M3 - Journal article
C2 - 30578066
VL - 157
SP - 1324-1333.e6
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 4
ER -
ID: 246199232