Abstract
BACKGROUND: We aimed to evaluate the outcomes of endovascular reperfusion followed by delayed open aortic repair in patients with acute type A aortic dissection (ATAAD) and malperfusion syndrome (MPS), as well as risk factors for mortality associated with organ failure. METHODS: We retrospectively selected 777 patients with ATAAD admitted to our center. Patients with MPS (n = 121; 15.6%), who were hemodynamically stable and without evidence of aortic rupture/tamponade, underwent interventional reperfusion (IR) through aortic/mesenteric branch stenting, followed by delayed open aortic repair (OR). Patients without MPS (non-MPS) (n = 656; 84.4%) received immediate open aortic repair. RESULTS: Overall hospital mortality was 37.2% in patients with ATAAD and MPS, significantly higher than in those without MPS (8.2%). However, patients with MPS who successfully underwent delayed repair after stenting had hospital mortality rates comparable to non-MPS patients (11.7% vs. 8.2%; p = 0.306) and similar short-term survival. Hypertension, leukocytosis, fibrin degradation products (FDP), D-dimer, and FDP/D-dimer ratios were independent predictors of mortality associated with irreversible organ failure. CONCLUSION: Endovascular stenting followed by delayed open aortic repair in stable patients with ATAAD and MPS had favorable short-term outcomes. Stenting of the aorta and/or aortic branches is a relatively simple, minimally invasive intervention with short-term patency.