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Malperfusion in acute type A aortic dissection: An update from the Nordic Consortium for Acute Type A Aortic Dissection
| Content Provider | Scilit |
|---|---|
| Author | 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 |
| Copyright Year | 2018 |
| Description | Journal: Journal of Thoracic and Cardiovascular Surgery To evaluate the effect of preoperative malperfusion on 30-day and late mortality, and postoperative complications, using data from the NORCAAD registry. We studied 1,159 patients who underwent ATAAD surgery between January 2005 and December 2014 at eight Nordic centers. Multivariable logistic and Cox regression analyses were performed to identify independent predictors of 30-day and late mortality. Preoperative malperfusion was identified in 381 of 1,159 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 (OR, 2.76; 95% CI, 1.94‒3.93), cardiac malperfusion (OR, 2.37; 95% CI, 1.34‒4.17), renal malperfusion (OR, 2.38; 95% CI, 1.23‒4.61) and peripheral malperfusion (OR, 1.95; 95% CI, 1.26‒3.01). Any malperfusion (HR, 1.72; 95% CI, 1.21‒2.43), cardiac malperfusion (HR, 1.89; 95% CI, 1.24‒2.87) and gastrointestinal malperfusion (HR, 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=0.009). Malperfusion has a significant impact 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. |
| Related Links | http://www.jtcvs.org/article/S0022522318329283/pdf |
| ISSN | 00225223 |
| e-ISSN | 1097685X |
| DOI | 10.1016/j.jtcvs.2018.10.134 |
| Journal | Journal of Thoracic and Cardiovascular Surgery |
| Issue Number | 4 |
| Volume Number | 157 |
| Language | English |
| Publisher | Elsevier BV |
| Publisher Date | 2018-11-15 |
| Access Restriction | Open |
| Subject Keyword | Journal: Journal of Thoracic and Cardiovascular Surgery Acute Type A Aortic Dissection Aortic Valve Replacement Coronary Artery Bypass Grafting Confidence Interval Chronic Obstructive Pulmonary Disease Cardiopulmonary Bypass Computed Tomography Hypothermic Circulatory Arrest Hazard Ratio Intensive Care Unit Interquartile Range |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pulmonary and Respiratory Medicine Surgery Cardiology and Cardiovascular Medicine |
