title: Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection.
abstract: BACKGROUND
  Few data exist on clinical/imaging characteristics, management, and outcomes of patients with type A acute dissection and mesenteric malperfusion.
  
  
  METHODS
  Patients with type A acute dissection enrolled in the International Registry for Acute Dissection (IRAD) were evaluated to assess differences in clinical features, management, and in-hospital outcomes according to the presence/absence of mesenteric malperfusion. A mortality model was used to identify predictors of in-hospital mortality in patients with mesenteric malperfusion.
  
  
  RESULTS
  Mesenteric malperfusion was detected in 68 (3.7%) of 1809 patients with type A acute dissection. Patients with mesenteric malperfusion were more likely to be older and to have coma, cerebrovascular accident, spinal cord ischemia, acute renal failure, limb ischemia, and any pulse deficit. They were less likely to undergo surgical/hybrid treatment (52.9% vs 87.9%) and more likely to receive only medical (30.9% vs 11.6%) or endovascular (16.2% vs 0.5%) management (P < .001). Overall in-hospital mortality was 63.2% and 23.8% in patients with and without mesenteric malperfusion, respectively (P < .001). In-hospital mortality of patients with mesenteric malperfusion receiving medical, endovascular, and surgical/hybrid therapy was 95.2%, 72.7%, and 41.7%, respectively (P < .001). At multivariate analysis, male gender (odds ratio [OR], 1.7; P = .002), age (OR, 1.1/y; P = .002), and renal failure (OR, 5.9; P = .020) were predictors of mortality whereas surgical/hybrid management (OR, 0.1; P = .005) was associated with better outcome.
  
  
  CONCLUSIONS
  Type A acute aortic dissection complicated by mesenteric malperfusion is a rare but ominous complication carrying a high risk of hospital mortality. Surgical/hybrid therapy, although associated with 2-fold hospital mortality, appears to be associated with better long-term outcomes in the management of type A acute aortic dissection in this setting.
authors.affiliation: Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy. marco.dieusanio2@unibo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.forename: Himanshu J
authors.initials: HJ
authors.lastname: Patel
authors.forename: Stuart
authors.initials: S
authors.lastname: Hutchison
authors.forename: Toru
authors.initials: T
authors.lastname: Suzuki
authors.forename: Mark D
authors.initials: MD
authors.lastname: Peterson
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Folesani
authors.forename: Reed E
authors.initials: RE
authors.lastname: Pyeritz
authors.forename: Alan C
authors.initials: AC
authors.lastname: Braverman
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Montgomery
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007564:Japan; D016015:Logistic Models; D008297:Male; D065666:Mesenteric Ischemia; D008875:Middle Aged; D015999:Multivariate Analysis; D009656:North America; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013152:Splanchnic Circulation; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality