eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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1/2021
vol. 18
 
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abstract:
Original paper

The effects of DeBakey type acute aortic dissection and preoperative peripheral and cardiac malperfusion on the outcomes after surgical repair

Paolo Nardi
1
,
Carlo Bassano
1
,
Calogera Pisano
1
,
Claudia Altieri
1
,
Maria Sabrina Ferrante
1
,
Monica Greci
1
,
Dario Buioni
1
,
Fabio Bertoldo
1
,
Andrea Farinaccio
1
,
Giovanni Ruvolo
1

  1. Cardiac Surgery Unit, Tor Vergata University, Rome, Italy
Kardiochir Torakochir Pol 2021; 18 (1): 1-7
DOI: https://doi.org/10.5114/kitp.2021.105187
Online publish date: 2021/05/15
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Introduction
Emergent surgical repair of DeBakey type I and II acute aortic dissection represents the standard of care to prevent lethal complications.

Aim
Evaluation of the effect of extension of aortic dissection (AAD) according to DeBakey classification, type I and II AAD, and the relationship with preoperative peripheral and myocardial malperfusion on early outcome and the mid-term follow-up period.

Material and methods
A total of 135 patients who underwent AAD surgery between January 2015 and October 2019 were analysed.

Results
In total 103 patients were affected by DeBakey type I AAD and 32 by DeBakey type II; 56 patients preoperatively showed peripheral, cardiac malperfusion, or both. Intra-operative mortality was 11%. Postoperative peripheral, cardiac malperfusion, and intraoperative and postoperative mortality were lower for type II AAD. The protective factor for intra- and postoperative 60-day mortality was type II AAD (RR = 0.03, p = 0.001); independent predictors were hypertension, and preoperative cardiac and renal-visceral malperfusion. At 5 years the overall survival was 74 ±6.9%. Independent predictors of reduced survival were major extension of type I AAD (RR = 5.37, p < 0.05) and preoperative cardiac malperfusion (RR = 5.78, p < 0.05). Five-year freedom from cardiac death, redo surgical operation, and new vascular procedures on the thoracic and abdominal aorta was 92 ±5.7%, 99 ±1.2%, and 81 ±7.2%, respectively. Extension of DeBakey type I AAD into the thoracic-abdominal aorta segment was also a predictor of the need for new vascular procedures (RR = 1.66, p = 0.05).

Conclusions
A more favourable anatomy of DeBakey type II AAD is associated with better early and late outcomes after aortic repair. This is due to a lower incidence of peripheral and cardiac malperfusion.

keywords:

type I, II aortic dissection, malperfusion
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