E-ISSN 2146-8133
 

Original Research (Original Article) 


In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion

Paolo Nardi, Dionisio F. Colella, Marco Russo, Guglielmo Saitto, Antonio Scafuri, Carlo Bassano, Antonio Pellegrino, Giovanni Ruvolo.

Abstract
Aims: To evaluate the effect of postoperative malperfusion (PM) on operative mortality and on late survival in patients who underwent surgery for acute type A aortic dissection in a referred center for aortic emergency surgery.
Patients and Methods: From January 2005 to September 2015, 237 patients were referred for aortic emergency surgery at our center. We examined complete data available on 214 patients (mean age 62.5±12.6 years, 156 males). At presentation, various types of preoperative malperfusion (cerebral, renal, mesenteric) were observed in 119 patients (55.6%). Arterial access for cardiopulmonary bypass was via femoral artery (n = 99), via axillary artery (n = 99), or into the ascending aorta (n = 22). Aortic repair was performed using an open technique in 124 patients (58%).
Results: Fifty-five patients (25.7%) presented PM; operative mortality was 29% (62/214): 47.3% in PM patients vs. 22.6% in non-PM patients (P < 0.0001). Independent predictors were age >75 years at the time of operation (OR: 1.1, P = 0.0004) and renal PM (OR: 53.5, P = 0.0027). Five-year survival was 79±7% in PM vs. 94±3% in non-PM patients (P = 0.002). Independent predictors for reduced survival were age >75 years (OR: 375, P = 0.05) and renal PM (OR: 28.6, P = 0.01). All types of PM and the location of intimal tear distal to the ascending aorta were found as risk factors for survival in the univariate analysis only (P < 0.05).
Conclusions: Surgery for acute aortic dissection is effective in reducing preoperative malperfusion by about 50%. Renal PM is associated with higher operative mortality, whereas all types of PM, in particular renal PM, negatively affected late survival. Surgical techniques, site of arterial cannulation, and more complex interventions requiring an open technique did not appear to be predictors of increased risk.

Key words: Type A acute aortic dissection, aortic surgery, preoperative malperfusion, postoperative malperfusion


 
ARTICLE TOOLS
Abstract
PDF Fulltext
Print this article Print this Article
How to cite this articleHow to cite this article
Export to
Export to
Related Records
 Articles by Paolo Nardi
Articles by Dionisio F. Colella
Articles by Marco Russo
Articles by Guglielmo Saitto
Articles by Antonio Scafuri
Articles by Carlo Bassano
Articles by Antonio Pellegrino
Articles by Giovanni Ruvolo
on Google
on Google Scholar
Article Statistics
 Viewed: 973
Downloaded: 172
Cited: 0

How to Cite this Article
Pubmed Style

Nardi P, Colella DF, Russo M, Saitto G, Scafuri A, Bassano C, Pellegrino A, Ruvolo G. In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. Arch Clin Exp Surg. 2017; 6(4): 175-182. doi:10.5455/aces.20160816012549


Web Style

Nardi P, Colella DF, Russo M, Saitto G, Scafuri A, Bassano C, Pellegrino A, Ruvolo G. In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. http://www.ejmaces.com/?mno=225057 [Access: May 26, 2018]. doi:10.5455/aces.20160816012549


AMA (American Medical Association) Style

Nardi P, Colella DF, Russo M, Saitto G, Scafuri A, Bassano C, Pellegrino A, Ruvolo G. In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. Arch Clin Exp Surg. 2017; 6(4): 175-182. doi:10.5455/aces.20160816012549



Vancouver/ICMJE Style

Nardi P, Colella DF, Russo M, Saitto G, Scafuri A, Bassano C, Pellegrino A, Ruvolo G. In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. Arch Clin Exp Surg. (2017), [cited May 26, 2018]; 6(4): 175-182. doi:10.5455/aces.20160816012549



Harvard Style

Nardi, P., Colella, D. F., Russo, M., Saitto, G., Scafuri, A., Bassano, C., Pellegrino, A. & Ruvolo, G. (2017) In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. Arch Clin Exp Surg, 6 (4), 175-182. doi:10.5455/aces.20160816012549



Turabian Style

Nardi, Paolo, Dionisio F. Colella, Marco Russo, Guglielmo Saitto, Antonio Scafuri, Carlo Bassano, Antonio Pellegrino, and Giovanni Ruvolo. 2017. In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. Archives of Clinical and Experimental Surgery (ACES), 6 (4), 175-182. doi:10.5455/aces.20160816012549



Chicago Style

Nardi, Paolo, Dionisio F. Colella, Marco Russo, Guglielmo Saitto, Antonio Scafuri, Carlo Bassano, Antonio Pellegrino, and Giovanni Ruvolo. "In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion." Archives of Clinical and Experimental Surgery (ACES) 6 (2017), 175-182. doi:10.5455/aces.20160816012549



MLA (The Modern Language Association) Style

Nardi, Paolo, Dionisio F. Colella, Marco Russo, Guglielmo Saitto, Antonio Scafuri, Carlo Bassano, Antonio Pellegrino, and Giovanni Ruvolo. "In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion." Archives of Clinical and Experimental Surgery (ACES) 6.4 (2017), 175-182. Print. doi:10.5455/aces.20160816012549



APA (American Psychological Association) Style

Nardi, P., Colella, D. F., Russo, M., Saitto, G., Scafuri, A., Bassano, C., Pellegrino, A. & Ruvolo, G. (2017) In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion. Archives of Clinical and Experimental Surgery (ACES), 6 (4), 175-182. doi:10.5455/aces.20160816012549





Most Viewed Articles
  • Hirudotherapy /Leech therapy: Applications and Indications in Surgery
    Swaid Abdullah, Latief M. Dar, Adil Rashid, Anita Tewari
    Arch Clin Exp Surg. 2012; 1(3): 172-180
    » Abstract & References » doi: 10.5455/aces.20120402072447

  • Role of Probiotics in Dental Caries and Periodontal Disease
    Amit Bhardwaj, Shalu V Bhardwaj
    Arch Clin Exp Surg. 2012; 1(1): 45-49
    » Abstract & References » doi: 10.5455/aces.20120212100645

  • Attenuated familial adenomatous polyposis presenting as an abdominal wall mass
    Marc Paul Jose Lopez, John Paul Senon Gonzalez, Manuel Francisco Tanada Roxas
    Arch Clin Exp Surg. 2017; 6(1): 53-55
    » Abstract » doi: 10.5455/aces.20150809085449

  • Use of Polyethylene Fiber (Ribbond) in Pediatric Dentistry
    Eda Arat Maden, Ceyhan Altun
    Arch Clin Exp Surg. 2012; 1(2): 110-115
    » Abstract & References » doi: 10.5455/aces.20120416115640

  • Role of Ultrasonography (“Honeycomb Sign”) in Early Detection of Dengue Hemorrhagic Fever
    Sudhir Sachar, Sunder Goyal, Saurabh Sachar
    Arch Clin Exp Surg. 2013; 2(1): 38-42
    » Abstract & References » doi: 10.5455/aces.20120828025157

  • Barium Enema in the Diagnosis of Hirschsprung’s Disease: A Comparison with Rectal Biopsy
    Mohammad Abbas, Arshad Rashid, Asim Rafiq Laharwal, Ajaz Ahmad Wani, Shabir Ahmad Dar, Manzoor Ahamad Chalkoo, Showkat Majeed Kakroo
    Arch Clin Exp Surg. 2013; 2(4): 224-228
    » Abstract & References » doi: 10.5455/aces.20120703031135

  • Long-Term Productive Cough Caused by Tracheal Bronchus
    Chih-Hao Chen, Shih-Yi Lee, Ho Chang, Tzu-Ti Hung
    Arch Clin Exp Surg. 2012; 1(2): 120-121
    » Abstract & References » doi: 10.5455/aces.20120311102403

  • A Review of the Prevention and Treatment of Hypertrophic Scars: Part I Clinical Aspects
    Huseyin Karagoz, Celalettin Sever, Yalcin Bayram, Cihan Sahin, Yalcin Kulahci, Ersin Ulkur
    Arch Clin Exp Surg. 2012; 1(4): 237-248
    » Abstract & References » doi: 10.5455/aces.20120218124923

  • Day–Care Surgery for Pilonidal Sinus Using Sinotomy Technique and Fibrin Glue Injection
    Selim Sozen, Vedat Ozturk, Koray Das, Hasan Erdem, Suleyman Cetinkunar, Ilhan Bali
    Arch Clin Exp Surg. 2012; 1(3): 138-141
    » Abstract & References » doi: 10.5455/aces.20120625121721

  • Scorpion sting in a pregnant woman: A case report
    Selim Bozkurt, Mehmet Okumus, Besime Utku, Deniz Cemgil Arikan, Ugur Lok, Fatma Betul Duygu
    Arch Clin Exp Surg. 2015; 4(2): 118-120
    » Abstract & References » doi: 10.5455/aces.20121229025033

  • Most Downloaded
  • Attenuated familial adenomatous polyposis presenting as an abdominal wall mass
    Marc Paul Jose Lopez, John Paul Senon Gonzalez, Manuel Francisco Tanada Roxas
    Arch Clin Exp Surg. 2017; 6(1): 53-55
    » Abstract » doi: 10.5455/aces.20150809085449

  • Role of Probiotics in Dental Caries and Periodontal Disease
    Amit Bhardwaj, Shalu V Bhardwaj
    Arch Clin Exp Surg. 2012; 1(1): 45-49
    » Abstract & References » doi: 10.5455/aces.20120212100645

  • Patient Selection in Plastic Surgery: Recognizing Body Dysmorphic Disorder
    Cihan Sahin, Onat Yilmaz, Yalcin Bayram, Huseyin Karagoz, Celalettin Sever, Yalcin Kulahci, Alpay Ates
    Arch Clin Exp Surg. 2013; 2(2): 109-115
    » Abstract & References » doi: 10.5455/aces.20120722123102

  • Hirudotherapy /Leech therapy: Applications and Indications in Surgery
    Swaid Abdullah, Latief M. Dar, Adil Rashid, Anita Tewari
    Arch Clin Exp Surg. 2012; 1(3): 172-180
    » Abstract & References » doi: 10.5455/aces.20120402072447

  • Use of Polyethylene Fiber (Ribbond) in Pediatric Dentistry
    Eda Arat Maden, Ceyhan Altun
    Arch Clin Exp Surg. 2012; 1(2): 110-115
    » Abstract & References » doi: 10.5455/aces.20120416115640

  • A Study of Methods Used to Reduce Surgical Site Infections
    Stuart R. Walker, Tara Anderson
    Arch Clin Exp Surg. 2012; 1(1): 27-33
    » Abstract & References » doi: 10.5455/aces.20120213053645

  • Slow-Release Drug Deliver System with Polylactic Acid Hydrogels in Prevention of Tracheal Wall Fibroplasia
    Jinrang Li, Lili Peng, Jianjun Sun, Hongguang Guo, Kun Guo, Zuogang Li, Yao Tang, Xu Sun, Shuangqing Zhang
    Arch Clin Exp Surg. 2012; 1(1): 1-7
    » Abstract & References » doi: 10.5455/aces.20120220105531

  • Principles of risk management in surgery departments
    Fatemeh Rezaei, Mohammad H Yarmohammadian, Masoud Ferdosi, Abbas Haghshenas
    Arch Clin Exp Surg. 2015; 4(3): 126-134
    » Abstract & References » doi: 10.5455/aces.20140925015830

  • Post-Traumatic Pancreatic Pseudocyst: Report of Two Cases with Review of Literature
    Sunder Goyal, Sudhir Sachar, Ram Kumar Verma, Snigdha Goyal
    Arch Clin Exp Surg. 2013; 2(4): 251-258
    » Abstract & References » doi: 10.5455/aces.20120524103614

  • A Review of the Prevention and Treatment of Hypertrophic Scars: Part I Clinical Aspects
    Huseyin Karagoz, Celalettin Sever, Yalcin Bayram, Cihan Sahin, Yalcin Kulahci, Ersin Ulkur
    Arch Clin Exp Surg. 2012; 1(4): 237-248
    » Abstract & References » doi: 10.5455/aces.20120218124923

  • Most Cited Articles
  • Hirudotherapy /Leech therapy: Applications and Indications in Surgery
    Swaid Abdullah, Latief M. Dar, Adil Rashid, Anita Tewari
    Arch Clin Exp Surg. 2012; 1(3): 172-180
    » Abstract & References » doi: 10.5455/aces.20120402072447
    Cited : 8 times [Click to see citing articles]

  • Experimental Craniofacial Composite Tissue Allotransplantation (CCTA) Models in Rats
    Yalcin Kulahci, Yalcin Bayram, Huseyin Karagoz, Celalettin Sever, Cihan Sahin
    Arch Clin Exp Surg. 2012; 1(3): 181-187
    » Abstract & References » doi: 10.5455/aces.20120514010906
    Cited : 7 times [Click to see citing articles]

  • Thoracodorsal Artery Perforator Flap: Basic Surgical Determinants
    Celalettin Sever, Yalcin Bayram, Cihan Sahin
    Arch Clin Exp Surg. 2012; 1(4): 270-271
    » Abstract & References » doi: 10.5455/aces.20120506072849
    Cited : 6 times [Click to see citing articles]

  • Pre-expanded Supraclavicular Flap for Post-burn Neck Contractures
    Celalettin Sever, Cihan Sahin
    Arch Clin Exp Surg. 2012; 1(1): 61-62
    » Abstract & References » doi: 10.5455/aces.20120205090034
    Cited : 4 times [Click to see citing articles]

  • Day–Care Surgery for Pilonidal Sinus Using Sinotomy Technique and Fibrin Glue Injection
    Selim Sozen, Vedat Ozturk, Koray Das, Hasan Erdem, Suleyman Cetinkunar, Ilhan Bali
    Arch Clin Exp Surg. 2012; 1(3): 138-141
    » Abstract & References » doi: 10.5455/aces.20120625121721
    Cited : 4 times [Click to see citing articles]

  • The effect of Kristeller maneuver on maternal and neonatal outcome
    Gokhan Acmaz, Evrim Albayrak, Gokalp Oner, Murvet Baser, Gulsum Aykut, Gulender Tas Tekin, Gokmen Zararsiz, Iptisam Ipek Muderris
    Arch Clin Exp Surg. 2015; 4(1): 29-35
    » Abstract & References » doi: 10.5455/aces.20140328024258
    Cited : 4 times [Click to see citing articles]

  • What is the Most Appropriate Animal Model for Experimental Diabetic Neuropathy Studies ?
    Huseyin Karagoz, Mustafa Tansel Kendirli
    Arch Clin Exp Surg. 2012; 1(3): 199-200
    » Abstract & References » doi: 10.5455/aces.20120514012617
    Cited : 3 times [Click to see citing articles]

  • Anesthetic Burns – A Burn Injury Due to A Combination of Local Anaesthetic and Heat Pack
    Stuart Robert Walker
    Arch Clin Exp Surg. 2012; 1(2): 127-128
    » Abstract & References » doi: 10.5455/aces.20120206110836
    Cited : 3 times [Click to see citing articles]

  • A Review of the Prevention and Treatment of Hypertrophic Scars: Part II. Experimental Studies
    Huseyin Karagoz, Yalcin Bayram, Celalettin Sever, Cihan Sahin, Yalcin Kulahci, Ersin Ulkur
    Arch Clin Exp Surg. 2013; 2(1): 49-58
    » Abstract & References » doi: 10.5455/aces.20120218125115
    Cited : 3 times [Click to see citing articles]

  • Students’ View of Evidence-Based Medicine: A Survey in Switzerland
    Reto Kaderli, Larissa Burghardt, Carina Hansali, Adrian Businger
    Arch Clin Exp Surg. 2012; 1(1): 34-40
    » Abstract & References » doi: 10.5455/aces.20120217124737
    Cited : 3 times [Click to see citing articles]