Table 2.
Comparison of intraoperative and postoperative outcomes between patients with type A aortic dissection with and without concurrent lower-extremity malperfusion
| Intraoperative variable | No LEM (n = 516) | LEM (n = 85) | P value |
|---|---|---|---|
| Cannulation strategy | .301 | ||
| Aortic | 426 (82.56) | 64 (75.29) | |
| Subclavian | 45 (8.72) | 9 (10.59) | |
| Femoral | 25 (4.84) | 8 (9.41) | |
| Distal aorta | |||
| Hemiarch replacement | 333 (64.53) | 40 (47.06) | .002 |
| Total arch replacement | 168 (32.56) | 43 (50.59) | .001 |
| Conventional elephant trunk | 29 (5.62) | 10 (11.76) | .033 |
| Frozen elephant trunk | 47 (9.11) | 18 (21.18) | <.001 |
| Cardiopulmonary bypass time (min) | 199 ± 73.7 | 230 ± 69.8 | <.001 |
| Ischemic time (min) | 135 ± 61.0 | 159 ± 60.9 | .001 |
| Antegrade cerebral perfusion time (min), median (IQR) | 0.0 (0.0-25.0) | 15.0 (0.0-37.0) | .004 |
| Retrograde cerebral perfusion time (min), median (IQR) | 19.0 (0.0-27.0) | 20.0 (0.0-27.0) | .886 |
| Low body HCA time | 29.8 ± 14.9 | 32.9 ± 13.6 | .140 |
| Lowest core temperature | 22.4 ± 4.47 | 20.7 ± 2.10 | .003 |
| RBC transfusion | 203 (39.34) | 49 (57.65) | .002 |
| Total procedure time (h) | 5.16 ± 2.07 | 6.07 ± 2.37 | <.001 |
| Proximal reconstruction | |||
| Aortic valve resuspension | 311 (60.3) | 48 (56.5) | .508 |
| Aortic valve replacement | 32 (6.2) | 5 (5.9) | 1.00 |
| Valve-sparing root replacement | 104 (20.2) | 18 (21.2) | .828 |
| Complete aortic root replacement | 96 (18.6) | 15 (17.7) | .833 |
| Mechanical valve implant | 39 (7.6) | 6 (7.1) | 1.00 |
| Bioprosthetic valve implant | 55 (10.7) | 9 (10.6) | .984 |
| Postoperative outcome variables | |||
| In-hospital mortality | 53 (10.3) | 16 (18.8) | .02 |
| Total postoperative length of stay (d), median (IQR) | 8 (6-13) | 10.6 (6-18) | .12 |
| Follow-up time (y), median (IQR) | 4.6 (1.7-7.8) | 4.6 (1.2-7.8) | .59 |
| Mechanical ventilation time (h), median (IQR) | 11.3 (5.9-27.4) | 12.9 (6.0-52.0) | .097 |
| Lower-extremity fasciotomy | 1 (1.43) | 4 (26.67) | .003 |
| New-onset cerebrovascular accident | 19 (3.7) | 7 (8.2) | .06 |
| New-onset atrial fibrillation | 205 (39.7) | 39 (45.9) | .28 |
| Reexploration for bleeding | 49 (9.5) | 5 (5.9) | .28 |
| New-onset renal failure requiring hemodialysis | 46 (8.9) | 22 (25.9) | <.001 |
| Red blood cell transfusion | 197 (38.2) | 49 (57.7) | <.001 |
LEM, Lower-extremity malperfusion; IQR, interquartile range; HCA, hypothermic circulatory arrest; RBC, red blood cell.