Table 2. Lab Indications of Malperfusion Syndrome and Percentage of Mortality

The values in the table above represent an aggregate of critical MPS values, and the associated mortalities that have been documented.

The proposed laboratory investigations should be organized into a standard panel designated the “aortic dissection panel,” and should be ordered STAT. Additionally, three units of fresh frozen plasma, two units of platelets, and two cryoprecipitate should also be reserved for this patient until a decision to proceed with surgery has been made.

The Mortality Risk Score

As previously mentioned, Ghoreishi, et al, have proposed a novel mortality risk score for TAAD.20 This score, as presented in Table 3, is based on the lactic acid level, the creatinine, and whether or not there is liver failure:

Our analysis is that this score presents an incomplete picture and, although it is predictive of mortality risk, there are additional factors that should be considered. We would suggest that a multicenter study, utilizing the data points from the proposed standardized lab panel could be used to further refine this equation. This is an area that we would recommend for additional study.

Conclusion

Acute aortic dissection is a devastating disease with extremely high potential for mortality and morbidity. The presence of malperfusion syndrome can significantly increase the patient’ s risk and in some cases can predict the inability to prevent mortality even with surgical repair.

The hallmark of assessing malperfusion syndrome is, and always will remain, a combination of examination, imaging, and laboratory assessment. Laboratory assessment, however, has been shown to have predictive value when determining the patient survivability. The establishment of a standard panel of laboratory investigations that can be ordered and resulted prior to the patient undergoing surgery can provide the surgeon with the necessary tools to plan or modify their approach, or even to forgo a predictively futile attempt to save the patient’s life by surgical intervention.

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