CONGRESS ABSTRACT

Introduction: Acute type A aortic dissection is a life-threatening condition with high postoperative mortality. Organ malperfusion is a major independent predictor of poor outcomes, with cerebral malperfusion (CM) being the most frequent and clinically relevant manifestation, affecting up to 39% of patients and associated with a twofold increase in mortality and persistent neurological deficits. Early diagnosis is challenging, as conventional computed tomography may be insensitive in the early ischemic phase and advanced cerebral perfusion imaging is often unavailable in emergency settings. While plasma biomarkers are promising in ischemic stroke, their application in aortic dissection is limited by systemic inflammation and vascular injury. This pilot study aims to identify organ-specific biomarkers associated with preoperative CM in acute type A aortic dissection. Methods: This is a multicenter, biobank-based, case–control pilot study using samples and clinical data from European biobanks participating in the German Biobank Node. Fifty age- and sex-matched patients will be included: 5 with acute type A aortic dissection and confirmed preoperative CM based on neurological deficits and imaging findings, and 25 without evidence of malperfusion. Plasma samples will undergo targeted discovery proteomic analysis using liquid chromatography–tandem mass spectrometry, focusing on proteins related to neuronal injury. Multivariate LASSO regression will be applied to identify discriminative protein signatures. Selected candidates will be validated using enzyme-linked immunosorbent assay and correlated with neurological outcomes. Results: The analysis is expected to identify a panel of plasma proteins significantly associated with the presence of CM, differentiating affected patients from those without malperfusion. Identified protein signatures are anticipated to reflect key pathophysiological mechanisms of cerebral ischemia. Validated biomarkers are expected to demonstrate discriminatory performance and correlate with the severity of neurological injury. Conclusions: This pilot study evaluates the feasibility of a plasma proteomic approach for the early detection of cerebral malperfusion in acute type A aortic dissection. Identification of CM-specific biomarkers may support improved risk stratification, optimization of surgical, and personalization of neuroprotective management, providing a foundation for future large-scale prospective and interventional studies.