{
  "abstract": "Background/Objectives: Mesenteric malperfusion is the most lethal and least recognizable complication of acute type A aortic dissection. This study aimed to examine organ-specific malperfusion patterns and 30-day mortality in acute type 1 aortic dissection with iliac extension, and to evaluate whether the lactate-to-albumin ratio (LAR) and superior mesenteric artery (SMA) origin pattern add predictive value for mesenteric malperfusion syndrome within a “source–clearance” framework. Methods: In this retrospective single-center study, 80 consecutive patients with acute type 1 aortic dissection extending to the iliac arteries who underwent surgical repair between January 2020 and March 2026 were reviewed. Malperfusion (preoperative finding) and malperfusion syndrome (end-organ injury persisting despite central repair) were defined for six organ systems; visceral branch origin and planimetric true lumen ratio were assessed on computed tomography angiography (CTA). The primary endpoint was 30-day mortality. Results: Thirty-day mortality was 33.8%; 60% of patients had malperfusion, and mortality rose with the number of organs involved (0/1/≥2: 12.5%/32.1%/70.0%). Mesenteric malperfusion (n = 21) carried the highest mortality (71.4%); all nine patients who developed mesenteric syndrome died. Cerebral malperfusion was most frequent (n = 27); all nine who improved postoperatively survived, whereas mortality was 81.8% in the 22 who developed the syndrome. Preoperative shock or cardiopulmonary resuscitation (CPR) (odds ratio [OR] = 7.02), mesenteric malperfusion (OR = 6.24), LAR (OR = 1.07 per 0.01 unit) and Glasgow Coma Scale (GCS; OR = 0.75 per point) were independent predictors. LAR and SMA origin pattern were uncorrelated (r = −0.04) and together raised the area under the receiver operating characteristic curve (AUC) for mesenteric syndrome from 0.861 to 0.955; mortality was 75% with mixed SMA origin (n = 8). Conclusions: Malperfusion is a dose-dependent risk spectrum; mesenteric involvement is its most lethal component, increasing mortality six-fold independently of hemodynamic and metabolic status. Joint interpretation of LAR and SMA origin pattern offers a practical, validation-pending framework for perioperative management of the mesenteric circulation in centers without a hybrid operating room.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiovascular Surgery, Bursa City Hospital, Bursa Faculty of Medicine, University of Health Sciences, 16110 Bursa, Türkiye"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ali Onder Kilic",
      "orcid": "0000-0002-0097-9082"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dwhr77y49ygvb.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15207958",
  "fulltext_url": null,
  "id": "dwhr77y49ygvb",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/7958",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Aortic Disease and Treatment Approaches"
    ]
  ],
  "openalex": "W7221822170",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-14",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/dwhr77y49ygvb.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15207958",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/7958"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Aortic Disease and Treatment Approaches",
      "subfield": "general"
    }
  ],
  "title": "Organ Malperfusion and Mortality in Acute Type 1 Aortic Dissection with Iliac Extension: A Retrospective Single-Center Study Focused on Mesenteric Malperfusion and the Source–Clearance Hypothesis",
  "title_text": "Organ Malperfusion and Mortality in Acute Type 1 Aortic Dissection with Iliac Extension: A Retrospective Single-Center Study Focused on Mesenteric Malperfusion and the Source–Clearance Hypothesis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:00Z",
  "url": "https://research.draconitic.com/paper/dwhr77y49ygvb",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}