Lower-extremity malperfusion syndrome in patients undergoing proximal aortic surgery for acute type A aortic dissectionCentral MessagePerspective

• Published in: JTCVS open 2023-09, Vol.15, p.1-13
• Main Authors: Irsa Hasan, MD, James A. Brown, MD, MS, Derek Serna-Gallegos, MD, Jianhui Zhu, MS, PhD, Joseph Garvey, BA, Sarah Yousef, MD, Ibrahim Sultan, MD
• Format: Article
• Language: English
• Subjects: aortic dissection; aortic repair; limb ischemia; malperfusion syndrome; peripheral vascular disease; revascularization
• ISSN: 2666-2736; 2666-2736

Objective: Data regarding management of lower-extremity malperfusion in the setting of type A aortic dissection are limited. This study aimed to compare acute type A aortic dissection with lower-extremity malperfusion outcomes in patients undergoing lower-extremity revascularization with no revascularization. Methods: Consecutive patients undergoing acute type A aortic dissection surgery were identified from a prospectively maintained database. Perioperative variables were compared between patients with and without lower-extremity malperfusion. Factors associated with lower-extremity malperfusion, revascularization, and mortality were determined using univariable Cox regression and Firth's penalized likelihood modeling. Results: From January 2007 to December 2021, 601 patients underwent proximal aortic repair for acute type A aortic dissection at a quaternary care center. Of these, 85 of 601 patients (14%) presented with lower-extremity malperfusion and were more often male (P = .02), had concomitant moderate or greater aortic insufficiency (P = .05), had lower ejection fraction (P = .004), had preoperative dialysis dependence (P = .01), and had additional cerebral, visceral, and renal malperfusion syndromes (P