Management of Malperfusion Syndrome in Acute Type A Aortic Dissection

E. Turner MD FCS(SA)Instituto Nacional del Tórax

Clínica Santa MaríaSantiago, Chile

No disclosures

Mechanism

STS/EACTS Latin America Cardiovascular Surgery Conference 2017

Ann Thorac Surg 2014;98:59–64

N %

Malperfusion 717 34

O.R. Death

Peripheral 270 13 1.4

Cerebral 236 11 2.2

Coronary 205 10 9.5

Renal 185 9

Visceral 124 6 3.2

Spinal 44 2 2.2

Operative Mortality (%)Ref N Overall Malperf- Malperf +

Geirsson 2007 221 13 6 31

Girdauskas 2009 276 19 14 29

Cho 2014 268 8 5 25

Immer 2006 227 13 10 19

Lawton 2018 282 18 11 36

Ghoreishi 2018 269 16 6 29

Uchida 2018 355 6 3 18

Pacini 2013 502 21 15 44

Czerny 2015 2137 17 13 21-43

Malperfusion Management

1 Central aortic repair

2 Central aortic repair and f.e.t.

3 Peripheral reperfusion first

4 Compassionate care

Coronary Malperfusion

Cerebral Malperfusion

STS/EACTS Latin America Cardiovascular Surgery Conference 201712

STS/EACTS Latin America Cardiovascular Surgery Conference 201713

Patel J Thorac Cardiovasc Surg 2008;135:1288- 96

The mean age of the patients was 57.1

years, and 173 patients underwent op-

erative repair (n=126 UC group; n=47

MP group). The remaining 23 patients in

the MP group died before repair from

complications of malperfusion (11) or

aortic rupture (12) while awaiting

resolution of the malperfusion syndrome

STS/EACTS Latin America Cardiovascular Surgery Conference 201715

Lawton J Thorac Cardiovasc Surg 2018;155:897-904

Hybrid operating room concept for combined diagnostics, intervention and surgery in acute type A dissection†

Eur J Cardiothorac Surg. 2012;43(2):397-404. doi:10.1093/ejcts/ezs287

Eur J Cardiothorac Surg | © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic

Surgery. All rights reserved.

I think your concept is unbelievably good

and in 10 years from now probably all the

aortic dissections will be done under

those circumstances.

APPENDIX. CONFERENCE DISCUSSION

Dr A. Haverich (Hannover, Germany):

THANK YOU