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Title: Optimal management of acute type A aortic dissection with mesenteric malperfusion.
Austin Authors: Perera, Nisal K;Galvin, Sean D;Seevanayagam, Siven ;Matalanis, George 
Affiliation: Department of Cardiac Surgery, The Austin Hospital, Heidelberg, Victoria, Australia
Department of Cardiac Surgery, The Austin Hospital, Heidelberg, Victoria, Australia
Issue Date: 28-Apr-2014
Publication information: 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.
Gov't Doc #: 24778143
DOI: 10.1093/icvts/ivu127
Type: Journal Article
Subjects: Acute
Mesenteric malperfusion
Type A aortic dissection
Acute Disease
Endovascular Procedures.adverse effects.mortality
Evidence-Based Medicine
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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