ORIGINAL RESEARCH article
Front. Surg.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1618755
Emergency Central Aortic Repair in Acute Type A Aortic Dissection Complicated by Malperfusion
Provisionally accepted
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract Objective: To assess outcomes of emergency central aortic repair (ECAR) in patients with acute type A aortic dissection (ATAAD) complicated by malperfusion, focusing on in-hospital mortality and long-term survival. Methods: This retrospective cohort study included 545 ATAAD patients treated surgically at a single center. Patients were stratified into malperfusion (n = 149) and non-malperfusion (n = 396) groups. Preoperative laboratory parameters, intraoperative strategies, and postoperative outcomes were compared. Kaplan–Meier analysis evaluated long-term survival. Results: Patients with malperfusion presented with significantly higher D-dimer and creatinine levels and more frequent emergency surgery (73.8% vs 63.9%, P=0.028). In-hospital mortality was similar between malperfusion and non-malperfusion groups (16.1% vs 14.1%, P=0.60), but increased with the number of affected organs: 13.3% (single), 18.4% (double), and 30.8% (triple or more). Cardiac and cerebral malperfusion had the highest mortality (40.0%). At 60 months, survival was significantly lower in malperfusion patients (60% vs 70%, log-rank P=0.00035). Conclusion: ECAR provides acceptable early survival in ATAAD patients with malperfusion. However, multi-organ involvement significantly worsens both in-hospital and long-term outcomes.
Keywords: Acute type A aortic dissection, Malperfusion, emergency, Aortic repair, prognosis
Received: 26 Apr 2025; Accepted: 12 Sep 2025.
Copyright: © 2025 BARNABO NAMPOUKIME, Monteiro, Wang and Pan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kan-paatib BARNABO NAMPOUKIME, barnabo06@gmail.com
You Min Pan, panyoumin@126.com
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