Outcomes of Lower Extremity Malperfusion Syndrome in Patients Undergoing Proximal Type A Aortic Dissection Repair
Presented During:
Saturday, May 6, 2023: 8:45AM - 9:00AM
Los Angeles Convention Center
Posted Room Name:
515B
Abstract No:
3
Submission Type:
Abstract Submission
Authors:
Irsa Hasan (1), James Brown (1), Derek Serna-Gallegos (1), Jianhui Zhu (1), Joseph Garvey (1), Ibrahim Sultan (1)
Institutions:
(1) University of Pittsburgh Medical Center, Pittsburgh, PA
Co-Author(s):
James Brown
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Derek Serna-Gallegos
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Jianhui Zhu
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Joseph Garvey
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
*Ibrahim Sultan
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Abstract:
OBJECTIVE: In the setting of type A aortic dissection (TAAD), there is limited literature comparing outcomes in patients presenting with lower extremity malperfusion (LEM). The purpose of this study was to compare outcomes in acute TAAD with concomitant LEM in patients undergoing lower extremity revascularization to no revascularization.
METHODS: Consecutive patients undergoing surgery for acute TAAD were identified from a prospectively maintained database. Perioperative variables were then compared between patients with and without LEM. Predictors of LEM, revascularization, and mortality were determined using univariable cox regression and Firth's penalized likelihood modeling.
RESULTS: A total of 601 patients from January 2007 to December 2021 underwent proximal aortic repair for acute TAAD at a quaternary care center. Of these, 85/601 (14%) patients presented with concomitant LEM. A comparison of perioperative variables between patients with and without LEM are described in Table 1. Kaplan-Meier estimated survival fared worse in patients with LEM compared to no LEM at 1, 5, and 10 years (84% vs 77%, 74% vs 71%, 65% vs 52%, p=0.03).
Within the LEM group, 15/85 (17%) patients underwent lower extremity revascularization. There were no significant differences in postoperative mortality and morbidity between the revascularization and no revascularization groups except for more frequent lower extremity fasciotomy after revascularization (p=0.003). No patients required lower extremity amputations. Preoperative CT imaging showed iliac artery thrombosis (p=0.03) and partial false lumen thrombosis (p=0.05) more frequently in the revascularization group. Significant predictors of revascularization included peripheral vascular disease (HR 3.7 [1.0-14.0], p=0.05) and pulse deficit (HR 5.6 [1.3-24.0], p=0.02) at presentation. Multivariable analysis revealed Caucasian race (HR 0.37 [0.2-0.8], p=0.02) and atrial fibrillation (HR 5.0 [1.6-14.9], p=0.004) were associated with worse survival.
CONCLUSION: This study finds patients with TAAD and LEM more often have significant underlying comorbidities, higher complication rates, and decreased survival compared to those without LEM. Within the LEM group, lower extremity revascularization did not lead to significant differences in postoperative morbidity and mortality. Careful consideration and optimization of predictors of revascularization and mortality as described in this study may improve clinical outcomes.
METHODS: Consecutive patients undergoing surgery for acute TAAD were identified from a prospectively maintained database. Perioperative variables were then compared between patients with and without LEM. Predictors of LEM, revascularization, and mortality were determined using univariable cox regression and Firth's penalized likelihood modeling.
RESULTS: A total of 601 patients from January 2007 to December 2021 underwent proximal aortic repair for acute TAAD at a quaternary care center. Of these, 85/601 (14%) patients presented with concomitant LEM. A comparison of perioperative variables between patients with and without LEM are described in Table 1. Kaplan-Meier estimated survival fared worse in patients with LEM compared to no LEM at 1, 5, and 10 years (84% vs 77%, 74% vs 71%, 65% vs 52%, p=0.03).
Within the LEM group, 15/85 (17%) patients underwent lower extremity revascularization. There were no significant differences in postoperative mortality and morbidity between the revascularization and no revascularization groups except for more frequent lower extremity fasciotomy after revascularization (p=0.003). No patients required lower extremity amputations. Preoperative CT imaging showed iliac artery thrombosis (p=0.03) and partial false lumen thrombosis (p=0.05) more frequently in the revascularization group. Significant predictors of revascularization included peripheral vascular disease (HR 3.7 [1.0-14.0], p=0.05) and pulse deficit (HR 5.6 [1.3-24.0], p=0.02) at presentation. Multivariable analysis revealed Caucasian race (HR 0.37 [0.2-0.8], p=0.02) and atrial fibrillation (HR 5.0 [1.6-14.9], p=0.004) were associated with worse survival.
CONCLUSION: This study finds patients with TAAD and LEM more often have significant underlying comorbidities, higher complication rates, and decreased survival compared to those without LEM. Within the LEM group, lower extremity revascularization did not lead to significant differences in postoperative morbidity and mortality. Careful consideration and optimization of predictors of revascularization and mortality as described in this study may improve clinical outcomes.
ADULT CARDIAC:
Aorta and Great Vessels
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