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Mesenteric Malperfusion Syndromes in Type A Aortic Dissection: Current Management Strategies.

Pierre M Sfeir1, Khalil Issa2, Chakib M Ayoub3

  • 1American University of Beirut Medical Center, Department of Surgery, Beirut, Lebanon.

Journal of Cardiothoracic and Vascular Anesthesia
|July 4, 2021
PubMed
Summary

Acute type A aortic dissection with mesenteric malperfusion is a life-threatening emergency. While reperfusion-first strategies show promise, improved surgical outcomes for this complex condition require further research and consensus.

Keywords:
TEVARfenestrationmalperfusionsurgerythoracic endovascular aortic repairtype A dissection

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Acute type A aortic dissection presents a significant surgical emergency with high mortality and morbidity.
  • Mesenteric malperfusion complicates this condition, leading to extremely high mortality rates.
  • Recent decades have seen surgical innovations aimed at improving outcomes.

Purpose of the Study:

  • To review current management strategies for acute type A aortic dissection complicated by mesenteric malperfusion.
  • To evaluate the effectiveness of reperfusion-first strategies.
  • To identify areas for improvement and the need for a management consensus.

Main Methods:

  • Review of recent innovations in vascular and cardiothoracic surgery.
  • Analysis of reported outcomes for different surgical approaches.
  • Assessment of mortality rates associated with various management strategies.

Main Results:

  • Some studies indicate improved mortality with reperfusion-first strategies.
  • Despite innovations, significant challenges and high mortality persist.
  • A lack of general consensus on optimal management remains.

Conclusions:

  • Management of acute type A aortic dissection with mesenteric malperfusion remains challenging.
  • Reperfusion-first strategies may offer improved survival, but further evidence is needed.
  • Establishing a consensus on the best surgical approach is crucial for improving patient outcomes.