When Is Laparotomy for Mesenteric Ischemia After Aortic Dissection Futile?

Area of Science:

• Cardiovascular Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Mesenteric ischemia following aortic dissection can lead to sepsis and death.
• Emergency laparotomy is crucial for survival but may be futile in severe cases.
• This study investigates the role of laparotomy in patients with aortic dissection and mesenteric ischemia.

Purpose of the Study:

• To determine when laparotomy offers meaningful survival in patients with aortic dissection and mesenteric ischemia.
• To identify predictors of survival after laparotomy in this patient population.

Main Methods:

• A retrospective review of 145 patients with aortic dissection and mesenteric ischemia (2006-2022).
• Analysis of clinical characteristics and outcomes for 29 patients who underwent laparotomy.
• Statistical analysis of serum lactate and arterial pH as predictors of survival.

Main Results:

• 45% of patients undergoing laparotomy survived to discharge.
• Serum lactate >8 mmol/L and pH <7.30 were highly predictive of mortality (OR 16.5 and 14.4, respectively).
• Survival was 9% for patients with both severe lactatemia and acidosis, versus 90% for those without.

Conclusions:

• Lactic acidosis severity effectively identifies patients for whom laparotomy is futile after aortic dissection with mesenteric ischemia.
• Pre-operative lactate and pH levels are critical in guiding surgical decisions.
• This data can help optimize patient selection for laparotomy, improving outcomes.