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Outcomes of surgically treated type a aortic dissection with malperfusion syndrome: an asian multi-institutional cohort study

Year: 2026

Type: article

Abstract: This study evaluated mortality in surgically treated type A aortic dissection with malperfusion (mTAAD), identified malperfusion types associated with 30-day mortality, and assessed whether its prognostic impact persists beyond the early postoperative period. We analyzed 1021 patients with TAAD undergoing open surgery in Asia (2002–2018), including 209 with and 812 without preoperative malperfusion. Outcomes were 30-day mortality, overall mortality from surgery, and overall mortality from discharge, assessed using logistic regression and Cox proportional hazards models. Malperfusion was associated with higher 30-day mortality (28.7% vs. 15.8%; adjusted odds ratio [aOR], 1.93; 95% CI 1.32–2.84) and overall mortality from surgery (34.4% vs. 24.0%; adjusted hazard ratio [aHR], 1.36; 95% CI 1.01–1.83), but not mortality from discharge (aHR, 0.84; 95% CI 0.40–1.77). Among single-organ malperfusion, cerebral malperfusion was associated with 30-day mortality (aOR, 2.25; 95% CI 1.08–4.70). Compared with no malperfusion, 30-day mortality was higher with single-organ involvement (aOR, 1.86; 95% CI 1.23–2.86), but not significantly with two organs (aOR, 1.66; 95% CI 0.76–3.66). In surgically treated mTAAD, the prognostic impact of malperfusion is concentrated in the early postoperative period. Cerebral malperfusion is associated with high 30-day mortality, supporting its emphasis in preoperative risk stratification.

Source: Scientific Reports

DOI: 10.1038/s41598-026-77584-5