Malperfusion Syndromes in Type A Aortic Dissection

Mechanism of Injury

• Malperfusion results from pressurization of a false lumen within the aorta or its branch vessels resulting in reduced flow and cerebral ischemia.([FOOTNOTE=Pacini D, Leone A, Belotti LM, et al. Acute type A aortic dissection: significance of multiorgan malperfusion. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2013;43(4):820-826.],[ANCHOR=View Abstract],[LINK=/content/mitg/websites/languagemasters/emea/en-gb/support/clinical-evidence.html?id=883116]) In patients undergoing surgical repair of acute type A aortic dissection, the incidence of cerebral malperfusion is 16-33%.([FOOTNOTE=Bonser RS, Ranasinghe AM, Loubani M, et al. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. Journal of the American College of Cardiology. 2011;58(24):2455-2474.],[ANCHOR=View Abstract],[LINK=/content/mitg/websites/languagemasters/emea/en-gb/support/clinical-evidence.html?id=883096])

Associated Outcome

• The presence of malperfusion is associated with increased postoperative coma, delirium, and hospital mortality.^1,([FOOTNOTE=Geirsson A, Szeto WY, Pochettino A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2007;32(2):255-262.],[ANCHOR=View Abstract],[LINK=/content/mitg/websites/languagemasters/emea/en-gb/support/clinical-evidence.html?id=883099])