Prognostic impact of branch vessel involvement on organ malperfusion and mid-term survival in patients with acute type A aortic dissection

• Published in: International journal of cardiology Vol. 381; pp. 81 - 87
• Main Authors: Wang, Wendan, Wang, Lei, Chai, Chen, Sun, Qi, Yuan, Yue, Wang, Tiantian, Wu, Long, Tang, Zehai
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.06.2023
• Subjects: Acute Disease; Aortic dissection; Aortic Dissection - diagnosis; Aortic Dissection - diagnostic imaging; Blood Vessel Prosthesis Implantation - adverse effects; Branch vessel involvement; Humans; Kidney; Mortality; Organ malperfusion; Prognosis; Retrospective Studies; Treatment Outcome; Branch vessel involvement; CTA; Aortic dissection; ATAAD; Organ malperfusion; Mortality
• DOI: 10.1016/j.ijcard.2023.03.055
• ISSN: 0167-5273; 1874-1754

This study aimed to investigate the impact of branch vessel involvement on organ malperfusion and mid-term survival in patients with acute type A aortic dissection (ATAAD). Between January 2019 and December 2020, 493 consecutive patients with angiographically confirmed ATAAD were retrospectively analysed. Preoperative computed tomography angiography parameters (branch artery involvement, longitudinal extent of dissection) were reviewed. The incidence of organ malperfusion, in-hospital mortality, and mid-term outcomes of patients with and without branch vessel involvement were compared. Branch vessel involvement was detected in 407 patients (82.6%), and organ malperfusion was observed in 234 patients (47.5%). The incidence of organ malperfusion was significantly higher in patients with branch vessel involvement compared with patients without it (52.6% vs. 23.3%, p < 0.001). Patients with coronary artery involvement (32.5%) were more likely to manifest as clinical malperfusion, whereas it occurred only 19.4% in patients with renal artery involvement. In-hospital mortality was higher in patients with branch vessel involvement (19.9% vs. 8.1%, p = 0.010). Median follow-up time was 16.1 months. Two-year survival rate was lower in patients with branch vessel involvement (76.3% vs. 84.5%, p = 0.085) or organ malperfusion (68.3% vs. 86.0%, p < 0.001). Multivariable analysis identified cardiac, cerebral, visceral and renal malperfusion as independent predictors for in-hospital mortality. Only a small proportion of branch vessel involvement was associated with corresponding organ malperfusion in patients with ATAAD. Branch vessel involvement had a greater effect on short-term outcomes than mid-term survival, and organ malperfusion was related to a worse prognosis beyond it. •Most patients with ATAAD have branch vessel involvement.•Branch vessel involvement is not always associated with organ malperfusion.•Patients with coronary artery involvement are more likely to manifest as clinical malperfusion.•Patients with branch vessel involvement had a greater impact on in-hospital mortality than 2-year mortality.•Preoperative malperfusion was associated with a worse prognosis beyond branch vessel involvement.