期刊
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
卷 158, 期 3, 页码 675-+出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2018.11.127
关键词
acute type A aortic dissection; malperfusion syndrome; mesenteric malperfusion; endovascular fenestration/stenting; aortic surgery
资金
- National Heart, Lung, and Blood Institute of the National Institutes of Health [R01HL141891, K08HL130614]
- Phil Jenkins and Darlene Fund
- Joe D. Morris Collegiate Professorship
- David Hamilton Fund
- Phil Jenkins Breakthrough Fund in Cardiac Surgery
- Herbert Sloan Collegiate Professorship
- Jamie Buhr Fund
- Richard Nerod Fund
- Stephen J. Szatmari Fund
Objective: To assess outcomes of endovascular reperfusion followed by delayed open aortic repair for stable patients with acute type A aortic dissection and mesenteric malperfusion syndrome (mesMPS). Methods: Among 602 patients with acute type A aortic dissection who presented to our center from 1996 to 2017, all 82 (14%) with mesMPS underwent upfront endovascular fenestration/stenting. Primary outcomes were in-hospital mortality and long-term survival. Patients with acute type A aortic dissection with no malperfusion syndrome of any organ (n = 419) served as controls. Results: In-hospital mortality of all comers with mesMPS was 39%. After endovascular fenestration/stenting, 20 mesMPS patients (24%) died from organ failure and 11 patients (13%) died from aortic rupture before open aortic repair, 47 patients (58%) underwent aortic repair, and 4 patients (5%) survived without open repair. No patients died from aortic rupture during the second decade (2008-2017). The significant risk factors for death from organ failure after endovascular reperfusion were acute stroke (odds ratio, 23; 95% confidence interval, 4-144; P = .0008), gross bowel necrosis at laparotomy (odds ratio, 7; 95% confidence interval, 1.4-34; P = .016), and serum lactate >= 6 mmol/L (odds ratio, 13.5; 95 % confidence interval, 2-97; P = .0097). There was no significant difference in operative mortality (2.1% vs 7.5%; P = .50) or long-term survival between patients with mesMPS who underwent open aortic repair after recovering from mesMPS and patients with no malperfusion syndrome. Conclusions: In patients with acute type A aortic dissection with mesMPS, endovascular fenestration/stenting, and delayed open aortic repair achieved favorable short- and long-term outcomes. Surgeons should consider correcting mesenteric malperfusion before undertaking open aortic repair in patients with mesMPS, especially those with acute stroke, gross bowel necrosis at laparotomy, or serum lactate >= 6 mmol/L.
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