Malperfusion syndromes in acute type A aortic dissection do not affect long‐term survival in Chinese population: A 10‐year institutional experience

Background Preoperative malperfusion of acute type A aortic dissection (ATAAD) remains a catastrophic complication that is associated with high postoperative morbidity and mortality. The relationship between malperfusion and long‐term survival in the Chinese population is unknown. Methods A total of 771 patients who underwent ATAAD surgery between January 2009 and December 2018 at our center were included. In‐hospital mortality, complications, morbidity, and long‐term survival were analyzed. Results Preoperative malperfusion was identified in 292 of 771 patients (37.9%), the in‐hospital mortality rate was 20.9% in patients with preoperative malperfusion and 9.2% in those without. Independent predictors of in‐hospital mortality included any malperfusion (odds ratio [OR], 5.132; p = .001), pericardial tamponade (OR, 1.808; p = .046), advanced age (OR, 1.028; p = .003), and cardiopulmonary bypass time (OR, 1.008; p = .001). Immediate emergency surgery (OR, 0.492; p = .007) and antegrade cerebral perfusion perioperatively (OR, 0.477; p = .020) were protective against postoperative mortality. The postoperative survival rates at 1, 3, and 5 years were 94.4% ± 1.5%, 91.9% ± 1.8%, and 83.0% ± 3.2% in patients with malperfusion and 94.7% ± 1.1%, 90.2% ± 1.7%, and 84.4% ± 2.7%, respectively, in those without. Preoperative malperfusion did not significantly affect the long‐term outcomes of operative survivors (log‐rank p = .601). Conclusion Malperfusion resulted in an unfavorable prognosis in the short term, but showed almost equal long‐term survival in patients without malperfusion of ATAAD. Emergency central repair might be considered to further improve the outcomes of ATAAD with malperfusion.