title: [Early and Long Term Outcomes of Surgery for Acute Type A Aortic Dissection Complicated with Organ Malperfusion].
abstract: OBJECTIVE
  The purpose of this study was to evaluate early and long term outcomes of surgery for acute type A aortic dissection complicated with organ malperfusion.
  
  
  METHODS
  From January 2001 to October 2015, 336 consecutive patients (mean age 68.6±12.2, male 172) underwent surgery for acute type A aortic dissection at out center. Early and late outcomes were compared between patients accompanied with and without organ malperfusion.
  
  
  RESULTS
  Preoperative organ malperfusion was observed in 76 patients( 22.6%). That consisted of 38 neurological systems, 13 coronary, 8 visceral, and 26 extremities. Nine patients had 2 organ malperfusion. In-hospital mortality was 22.4% and 6.5% in patients with and without organ malperfusion, respectively. Multivariate logistic analysis showed preoperative organ malperfusion was a significant risk factor for in-hospital mortality (Odds ratio 3.59, 95% confidence interval 1.56~8.28, p<0.01). Five year survival rate of hospital survivors were 84.5±5.5% and 80.9±3.3% with and without organ malperfusion (p=0.51).
  
  
  CONCLUSIONS
  Although organ malperfusion is still associated with high mortality, however, acceptable long term outcomes could be obtained if organ malperfusion is treated appropriately. Ischemic organ oriented approach might be very important to improve surgical outcomes of these critically ill conditions.
authors.affiliation: Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Omura
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Nakai
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Minami
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ishigaki
authors.forename: Yojiro
authors.initials: Y
authors.lastname: Koda
authors.forename: Naoki
authors.initials: N
authors.lastname: Tateishi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tani
authors.forename: Soichiro
authors.initials: S
authors.lastname: Henmi
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Murakami
authors.forename: Tasuku
authors.initials: T
authors.lastname: Honda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuda
authors.forename: Masato
authors.initials: M
authors.lastname: Yoshida
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Mukohara
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications*; D008297:Male; D016896:Treatment Outcome