Impact of Mesenteric Ischemia in Patients with Type

Impact of Mesenteric Ischemia in Patients with Type A Acute Aortic Dissection O. Stiru MD Ph. D 1, C. A. Parasca MD 1, A. Pasare MD 1, C. N. Bulescu MD 1, S. I. Bubenek-Turconi MD Ph. D 2, C. Filipescu MD Ph. D 2, V. A. Iliescu MD Ph. D 1 1. Department of Cardiovascular Surgery, "C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest 2. Department of Anesthesia and Intensive Care, "C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest Figure 1. Superior mesenteric artery dissection Background: Mesenteric ischemia is a rare, but severe complication of type A acute aortic dissection and it is associated with a significant surgical morbidity and mortality. Method: Among 300 patients admitted for acute type A aortic dissection who underwent surgery between January 2005 - December 2013, only 9 patients(3. 2%) were complicated with visceral ischemia. Diagnosis of mesenteric ischemia was based on presence of abdominal pain and typical findings for peritoneal irritation at clinical examination, associated with severe metabolic acidosis, lactate increase or abnormal abdominal CT. After dividing the patients into two groups according to the presence or absence of mesenteric ischemia, comparisons of baseline characteristics were made and mortality rates were determined. Figure 2. Kaplan Meier survival curves Results: There were no differences in baseline characteristics between groups. The hospital mortality rate was 77. 8% (7 of 9) in patients with mesenteric ischemia, 25. 3%% (69 of 273) in patients without mesenteric ischemia (p = 0. 002), and an overall in-hospital mortality of 27. 0% (76 of 282) in all patients. The long-term overall mortality rate was 88. 9% (8 of 9) patients with mesenteric ischemia, 42. 0% (115 of 274) in patients without mesenteric ischemia (p = 0. 012), and an overall in-hospital mortality of 43. 5% (123 of 283). Multivariate analysis reveals mesenteric ischemia as the most important independent predictor of in-hospital mortality (OR=5. 91, 95% CI=0. 96 -36. 4). Table 1. Multivariate analysis Complications OR CI P-value Myocardial infarction 2. 453 0. 96 -6. 27 0. 061 Visceral ischemia 5. 906 0. 96 -36. 3 0. 056 Peripheral ischemia 4. 152 1. 29 -13. 3 0. 017 Cardiovascular dysfunction 5. 520 2. 33 -13. 1 <0. 001 MSOF 3. 515 1. 80 -6. 85 <0. 001 Conclusion: Although rare, acute type A aortic dissection complicated with mesenteric ischemia has the highest postoperative mortality and morbidity. References 1. Survival, Neurologic Injury, and Kidney Function after Surgery for Acute Type A Aortic Dissection. Schoenrath F, et al. The Thoracic and cardiovascular surgeon. Sep 3 2015. 2. Mortality in patients with acute aortic dissection type A-analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Bachet J 1. Eur J Cardiothorac Surg. 2016 Feb; 49(2): e 52 -3.