Background: Malperfusion syndrome (MPS) presents a great challenge in treating acute type A aortic dissection (ATAAD) and has a high mortality despite a technically successful operation. We aimed to evaluate the long-term outcomes and progression of the distal aorta in acute type A aortic dissection patients with MPS treated with endovascular fenestration/stenting (F/S) followed by open aortic repair.

Methods: From January 1996-March 2021, 927 patients presented with ATAAD. Five-hundred-and-thirty-four patients had DeBakey I dissection with no-MPS and underwent immediate open repair (no-MPS group), while 97 patients with MPS underwent F/S and delayed open aortic repair (MPS group). Data were collected from the STS database, medical record review, survey, and the national death index (Dec 12, 2021). 

Results: Compared to the no-MPS group, the MPS group had more patients with hypertension (89% vs. 73%, p<0.001), and acute renal failure (60% vs. 4.3%, p<0.001. Both groups had similar aortic root and arch procedures. Postoperatively, the MPS group had similar operative mortality (5.2% vs. 7.9%, p=0.35), more new-onset dialysis (22% vs. 7.7%, p<0.001), similar permanent dialysis (4.7% vs. 2.9%, p=0.50), and prolonged ventilation (72% vs. 49%, p<0.001). The growth rate of the aortic arch (0.38 vs 0.35 mm/year, p=0.81) was similar between the MPS and no-MPS groups. The descending thoracic aorta (1.03 vs. 0.68 mm/year) and abdominal aorta growth rate (0.76 vs. 0.59 mm/year) were significantly higher in the MPS group. The cumulative incidence of reoperation over 10 years (16.2% vs. 17.7%, p=0.91) and 15-year survival outcome (50.4% vs 48.4%, p=0.43) were similar between MPS and no-MPS groups.

Conclusions: Endovascular fenestration/stenting followed by open aortic repair was a valid approach for patients with MPS.

Progression of Distal Aorta after Endovascular Fenestration/Stenting in Acute Type A Aortic Dissection

Clinical and Translational Research | Thoracic Surgery

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Progression of Distal Aorta after Endovascular Fenestration/Stenting in Acute Type A Aortic Dissection

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