Surgical Treatment for Acute Type A Aortic Dissection Associated with End-organ Malperfusion

Hideyuki Kunishige, Yoshimitsu Ishibashi, Masakazu Kawasaki, Kimihiro Yoshimoto, Nozomu Inoue

Hokkaido Medical Center, Sapporo, Japan

Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–B

Abstract

Although the results of surgical treatment for acute type A aortic dissection have improved because of progress in surgical techniques, the prognosis is still very poor and optimal therapeutic approach is still not clearly established for cases of acute dissection complicated with malperfusion. The purpose of this study was to investigate the current therapeutic strategy in acute type A aortic dissection associated with end-organ malperfusion.

Between January 2002 and December 2016, 99 patients with acute or subacute type A aortic dissection were treated surgically. Patient age ranged from 20 to 87 (average, 65) years. Of those, end-organ malperfusion were seen in 34, 13 patients (13.1%) had myocardial ischemia, 12 (12.1%) had neurologic deficit, 3 (3.0%) had visceral ischemia, and 13 (13.1%) had limb ischemia.

Concomitant CABG and revascularization for limb ischemia were performed in 12 and 4 patients, respectively. The operative mortality rate was 8.8%. It was significantly higher than that in patients with uncomplicated dissection.

For patients with leg ischemia, axillo-femoral bypass in 3, femoro-femoral bypass in 1, and fenestration of the abdominal aorta in 1 each. Visceral ischemia was related to the cause of death in all patients who died early after surgery. The hospital mortality rate in patients with compromised visceral artery was 66.7%. It was especially difficult to rescue patients with accompanying visceral ischemia due to dissection.

In conclusion, early diagnosis and surgical intervention before established infarction develops are essential to save patients with type A aortic dissection associated with end-organ malperfusion. The revascularization technique of choice for ischemic visceral organs depends on the mechanism of peripheral vascular obstruction induced by the dissection process.