[Optimal Management of Stanford Type A Acute Aortic Dissection with Mesenteric Malperfusion]

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Aortic Surgery

Context:

• Stanford type A acute aortic dissection (TAAAD) with mesenteric malperfusion (TAAADwM) presents complex management challenges.
• Optimal timing and approach for mesenteric malperfusion intervention remain debated.
• Computed tomography (CT) scans are crucial for suspecting TAAADwM, irrespective of other clinical indicators.

Purpose:

• To present and evaluate a surgical strategy for TAAADwM involving open superior mesenteric artery (SMA) bypass prior to aortic repair.
• To determine the necessity of pre-aortic repair intervention for mesenteric malperfusion.
• To assess the outcomes of this management approach.

Summary:

• The described strategy prioritizes open SMA bypass before aortic repair in suspected TAAADwM cases identified on CT scans.
• Mesenteric malperfusion treatment is not always dictated by symptoms, lactate levels, or intraoperative findings.
• A mortality rate of 21.4% in 14 patients was observed, considered acceptable for this high-risk group.

Impact:

• This approach may be suitable when sufficient time allows for open SMA bypass.
• It highlights the potential for open repair over endovascular options in specific scenarios.
• The strategy confirms the importance of enteric viability and hemodynamic stability in TAAADwM management.