title: The Impact of Pre-Operative Malperfusion on Outcome in Acute Type A Aortic Dissection: Results From the GERAADA Registry.
abstract: BACKGROUND
  Malperfusion adversely affects outcomes in patients with acute type A aortic dissection, but reliable quantitative data are lacking.
  
  
  OBJECTIVE
  The aim of this study was to analyze the impact of various forms of malperfusion on early outcome.
  
  
  METHODS
  A total of 2,137 consecutive patients enrolled in GERAADA (German Registry for Acute Aortic Dissection Type A) who underwent surgery between 2006 and 2010, of whom 717 (33.6%) had any kind of pre-operative malperfusion, were retrospectively analyzed.
  
  
  RESULTS
  All-cause 30-day mortality was 16.9% and varied substantially according to the number of organ systems affected by malperfusion (none, 12.6%; 1 system, 21.3%; 2 systems, 30.9%; 3 systems, 43.4%; p < 0.001). Pre-operative cerebral malperfusion, comatose state, peripheral malperfusion, visceral malperfusion, involvement of supra-aortic branches, coronary malperfusion, and renal malperfusion were all independent predictors of developing any post-operative malperfusion syndrome. When survival was considered, age, peripheral malperfusion, involvement of supra-aortic branches, coronary malperfusion, spinal malperfusion, a primary entry in the descending aorta, and pre-operative comatose state were independent predictors, again with increasing significance.
  
  
  CONCLUSIONS
  Malperfusion remains a severe clinical condition with strong potential for adverse outcomes in patients undergoing surgery for acute type A aortic dissection. The GERAADA registry suggests that the impact of the number of organs involved and the type of malperfusion on outcome differs substantially. Introducing an appropriate classification system, such as "complicated" and uncomplicated" acute type A aortic dissection, might help predict individual risk as well as select a surgical strategy that may quickly resolve malperfusion.
authors.affiliation: University Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland, and University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany. Electronic address: martin.czerny@uniklinik-freiburg.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.affiliation: University Clinic for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Schoenhoff
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Etz
authors.affiliation: University Clinic for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.affiliation: Department for Cardiac Surgery, University Hospital Munich, Munich, Germany.
authors.forename: Nawid
authors.initials: N
authors.lastname: Khaladj
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.affiliation: Department of Vascular and Endovascular Surgery, Clinic Hubertus Hospital, Berlin, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Weigang
authors.affiliation: Institute for Medical Biostatistics, Epidemiology and Informatics, Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Isabell
authors.initials: I
authors.lastname: Hoffmann
authors.affiliation: Institute for Medical Biostatistics, Epidemiology and Informatics, Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Blettner
authors.affiliation: University Clinic for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control; D011300:Preoperative Care / Q000401:mortality* / Q000639:trends; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: early outcome; independent predictor; supra-aortic