ArticleThe Journal of thoracic and cardiovascular surgery2025
Performance of the open-first repair strategy in type A aortic dissection with mesenteric malperfusion syndrome eligible for delayed repair.
Article in The Journal of thoracic and cardiovascular surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Organ-specific malperfusion in acute type A aortic dissection: epidemiological meta-analysis of incidence rates.BJS open · 2024Pooled it
- Extensive endovascular thoracoabdominal aortic septotomy for treatment of malperfusion in acute aortic dissection.Journal of vascular surgery cases and innovative techniques · 2026Article
- Transpericardial ultrasound-guided management of visceral malperfusion in acute type A aortic dissection.JTCVS techniques · 2026Article
- Outcome of Transfer Time Difference From Diagnosis to Operation Room in Acute Type A Aortic Dissection Complicated by Malperfusion.Annals of thoracic surgery short reports · 2025Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
objectiveFor patients with type A aortic dissection complicated by mesenteric malperfusion syndrome, some centers advocate a nontraditional approach based on up-front endovascular intervention and delayed open repair. However, the efficacy of this strategy cannot be understood without first understanding outcomes of the traditional open-first strategy in the same select patient population eligible for delayed repair, applying modern techniques of hybrid aortic surgery.
methodsPatients with acute type A aortic dissection and mesenteric malperfusion syndrome were queried from a single institution. Those presenting with aortic rupture, tamponade, or cardiogenic shock (ineligible for delayed repair) were excluded. Patients were managed with immediate open aortic repair. Short-term and long-term outcomes are reported.
resultsA total of 1228 patients were treated for acute type A dissection in the study period, of whom 77 were included in the mesenteric malperfusion syndrome cohort. In-hospital mortality was 29% compared with 39% in an identically selected mesenteric malperfusion syndrome population undergoing delayed repair reported previously. Among patients with mesenteric malperfusion syndrome, 32% underwent additional procedures addressing distal malperfusion in a hybrid operating room during or after open repair. Concomitant proximal malperfusion (coronary, cerebral, or upper extremity) was common in the mesenteric malperfusion syndrome cohort, present in 35% of cases. Although early mortality was greater in the mesenteric malperfusion syndrome cohort compared with all acute type A dissections, 10-year survival among those discharged alive was similar (65% vs 59%, P = .18).
conclusionsThe traditional open-first repair strategy performs equal to or better than the delayed repair strategy for patients with mesenteric malperfusion syndrome eligible for delayed repair.
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