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Lower-extremity malperfusion syndrome in patients undergoing proximal aortic surgery for acute type A aortic dissection
Open accessAbstract
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 < .001). Kaplan–Meier estimated survival fared worse with lower-extremity malperfusion compared with no lower-extremity malperfusion at 1, 5, and 10 years (84% vs 77%, 74% vs 71%, 65% vs 52%, respectively, P = .03). In the lower-extremity malperfusion group, 15 of 85 patients (18%) underwent lower-extremity revascularization without significant differences in postoperative morbidity and mortality compared with patients not undergoing revascularization. Need for peripheral revascularization was associated with peripheral vascular disease (hazard ratio, 3.7 [1.0-14.0], P = .05) and pulse deficit (hazard ratio, 5.6 [1.3-24.0], P = .02) at presentation. Conclusions Patients presenting with type A aortic dissection and lower-extremity malperfusion have worse overall survival compared with those without lower-extremity malperfusion. However, not all patients with type A aortic dissection and lower-extremity malperfusion require revascularization.
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References 27 · Cited by 5
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Metadata
- Authors
- Hasan, I., Brown, J. A., Serna-Gallegos, D., Zhu, J., Garvey, J., Yousef, S., & Sultan, I.
- Affiliations
- University of Pittsburgh (US)
- University of Pittsburgh Medical Center (US)
- Corresponding author
- Sultan, Ibrahim
- Venue
- JTCVS Open
- Publisher
- Elsevier BV
- Published
- 2023-09
- Volume
- 15
- Pages
- 1-13
- ISSN
- 2666-2736 (ISSN-L)
- PMC
- PMC10556830
- OpenAlex
- W4372341341
- Cited by
- 5
- References
- 27
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2
- FWCI
- 0.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- JTCVS Open (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Thrombus and Embolism
- Health Sciences › Medicine › Surgery › Aortic aneurysm repair treatments
- Keywords
- type A aortic dissection, lower extremity revascularization, peripheral vascular disease, pulse deficit, overall survival, aortic regurgitation, dialysis dependence, postoperative mortality, Cox proportional hazards model
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