{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:03:32Z","timestamp":1759190612066,"version":"3.44.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess outcomes of emergency central aortic repair (ECAR) in patients with acute type A aortic dissection (ATAAD) complicated by malperfusion, focusing on in-hospital mortality and long-term survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study included 545 ATAAD patients treated surgically at a single center. Patients were stratified into malperfusion (<jats:italic>n<\/jats:italic>\u2009=\u2009149) and non-malperfusion (<jats:italic>n<\/jats:italic>\u2009=\u2009396) groups. Preoperative laboratory parameters, intraoperative strategies, and postoperative outcomes were compared. Kaplan\u2013Meier analysis evaluated long-term survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with malperfusion presented with significantly higher D-dimer and creatinine levels and more frequent emergency surgery (73.8% vs. 63.9%, <jats:italic>P<\/jats:italic>\u2009=\u20090.028). In-hospital mortality was similar between malperfusion and non-malperfusion groups (16.1% vs. 14.1%, <jats:italic>P<\/jats:italic>\u2009=\u20090.60), but increased with the number of affected organs: 13.3% (single), 18.4% (double), and 30.8% (triple or more). Cardiac and cerebral malperfusion had the highest mortality (40.0%). At 60 months, survival was significantly lower in malperfusion patients (60% vs. 70%, log-rank <jats:italic>P<\/jats:italic>\u2009=\u20090.00035).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ECAR provides acceptable early survival in ATAAD patients with malperfusion. However, multi-organ involvement significantly worsens both in-hospital and long-term outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1618755","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T05:25:46Z","timestamp":1759123546000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Emergency central aortic repair in acute type A aortic dissection complicated by malperfusion"],"prefix":"10.3389","volume":"12","author":[{"given":"Kan-paatib","family":"Barnabo Nampoukime","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adeoumi Esperance","family":"Monteiro 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