Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/12197
Title: Optimal management of acute type A aortic dissection with mesenteric malperfusion.
Authors: Perera, Nisal K;Galvin, Sean D;Seevanayagam, Siven;Matalanis, George
Affiliation: Department of Cardiac Surgery, The Austin Hospital, Heidelberg, VIC, Australia sdavg-cts@yahooxtra.co.nz.
Department of Cardiac Surgery, The Austin Hospital, Heidelberg, VIC, Australia.
Issue Date: 28-Apr-2014
Citation: Interactive Cardiovascular and Thoracic Surgery 2014; 19(2): 290-4
Abstract: Acute type A aortic dissection (TAAD) remains a morbid condition; although overall outcomes have improved, patients presenting with preoperative malperfusion syndromes continue to have excessive mortality following conventional open surgical repair. Mesenteric malperfusion is generally associated with the worst prognosis and postoperative mortality in this group. With advances in the endovascular treatment of aortic pathology, options now exist to percutaneously manage mesenteric malperfusion prior to central aortic repair. This strategy may be associated with improved outcomes. To review this, a best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients with acute type A aortic dissections with mesenteric malperfusion, does management of the malperfusion prior to central aortic repair reduce perioperative mortality'. Overall, more than 309 papers were found as a result of the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that, in patients with acute TAAD complicated by mesenteric malperfusion, initial management with percutaneous interventional procedures to reverse the malperfusion followed by delayed central aortic repair is a reasonable strategy; this is because of the extremely poor prognosis associated with immediate central aortic repair in this group.
Internal ID Number: 24778143
URI: http://ahro.austin.org.au/austinjspui/handle/1/12197
DOI: 10.1093/icvts/ivu127
URL: http://www.ncbi.nlm.nih.gov/pubmed/24778143
Type: Journal Article
Subjects: Acute
Hybrid
Mesenteric malperfusion
Type A aortic dissection
Acute Disease
Aneurysm, Dissecting.complications.diagnosis.mortality.physiopathology.surgery
Aortic Aneurysm.complications.diagnosis.mortality.physiopathology.surgery
Benchmarking
Endovascular Procedures.adverse effects.mortality
Evidence-Based Medicine
Female
Humans
Male
Mesenteric Ischemia.diagnosis.etiology.mortality.physiopathology.therapy
Middle Aged
Risk Factors
Splanchnic Circulation
Treatment Outcome
Vascular Surgical Procedures.adverse effects.mortality
Appears in Collections:Journal articles

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