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Revascularization-first strategy in acute aortic dissection with mesenteric malperfusion.

Kayo Sugiyama1, Hirotaka Watanuki1, Masaho Okada1

  • 1Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Japan.

Journal of Cardiac Surgery
|August 26, 2020
PubMed
Summary

The revascularization-first strategy for acute aortic dissection with mesenteric malperfusion significantly lowers mortality. This approach led to no in-hospital deaths and faster recovery compared to central repair first.

Keywords:
acute aortic dissectionaorta and great vesselshybrid operation roommesenteric malperfusionrevascularization-first strategy

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Gastrointestinal Surgery

Background:

  • Mesenteric malperfusion in acute aortic dissection increases mortality risk.
  • Early diagnosis of mesenteric ischemia is challenging, often indicating a worsened patient condition.
  • A revascularization-first strategy may offer improved outcomes over traditional central repair-first approaches.

Purpose of the Study:

  • To present a revascularization-first strategy for acute aortic dissection with mesenteric malperfusion.
  • To evaluate the postoperative outcomes of this strategy.

Main Methods:

  • Retrospective review of 6 patients with acute type A aortic dissection and mesenteric malperfusion (Jan 2017-Dec 2019).
  • Four hemodynamically stable patients underwent mesenteric revascularization (endovascular) before central repair.
  • Two hemodynamically unstable patients underwent central repair before mesenteric revascularization.

Main Results:

  • No in-hospital mortality was observed in the study cohort.
  • Patients treated with the revascularization-first strategy showed complete recovery without mesenteric ischemia symptoms.
  • The central repair-first group experienced paralytic ileus, with one requiring exploratory laparotomy.

Conclusions:

  • The revascularization-first strategy is associated with excellent outcomes in acute aortic dissection involving mesenteric malperfusion.
  • This approach potentially reduces complications like paralytic ileus and the need for further surgical intervention.
  • No in-hospital mortality was recorded, highlighting the efficacy of the revascularization-first approach.