Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Japan.
J Card Surg. 2020 Nov;35(11):3004-3009. doi: 10.1111/jocs.14961. Epub 2020 Aug 25.
Mesenteric malperfusion is a complication with a higher risk of in-hospital mortality because diagnosing mesenteric ischemia before necrotic change is difficult, and when it occurs, the patient's condition has worsened. Although it contradicts the previous consensus on central repair-first strategy, the revascularization-first strategy was found to be significantly associated with lower mortality rates. This study aimed to present our revascularization-first strategy and the postoperative results for acute aortic dissection involving mesenteric malperfusion.
Among 58 patients with acute type A aortic dissection at our hospital between January 2017 and December 2019, mesenteric malperfusion was noted in six. Four hemodynamically stable patients underwent mesenteric revascularization with endovascular intervention in a hybrid operation room before central repair, and two hemodynamically unstable patients underwent central repair before mesenteric revascularization.
No in-hospital mortality was recorded. All four patients with mesenteric revascularization-first strategy recovered with no symptoms related to mesenteric ischemia. Two patients with central repair-first strategy developed paralytic ileus for 1 week; one of them needed exploratory laparotomy, but no patients needed colon resection.
No in-hospital mortality was recorded. All four patients with mesenteric revascularization-first strategy recovered with no symptoms related to mesenteric ischemia. Two patients with central repair-first strategy developed paralytic ileus for 1 week; one of them needed exploratory laparotomy, but no patients needed colon resection.
肠系膜灌注不良是一种并发症，其院内死亡率较高，因为在发生坏死性改变之前诊断肠系膜缺血较为困难，而且当发生这种情况时，患者的病情已经恶化。尽管这与先前关于中央修复优先策略的共识相矛盾，但血管再通优先策略被发现与较低的死亡率显著相关。本研究旨在介绍我们在涉及肠系膜灌注不良的急性主动脉夹层中的血管再通优先策略和术后结果。
在我院 2017 年 1 月至 2019 年 12 月期间收治的 58 例急性 A 型主动脉夹层患者中，有 6 例出现肠系膜灌注不良。4 例血流动力学稳定的患者在中央修复前于杂交手术室行血管内介入肠系膜血运重建，2 例血流动力学不稳定的患者在肠系膜血运重建前先行中央修复。
无院内死亡病例。所有行肠系膜血运重建优先策略的 4 例患者均无肠系膜缺血相关症状恢复。2 例行中央修复优先策略的患者出现麻痹性肠梗阻 1 周，其中 1 例需行剖腹探查术，但无患者需结肠切除术。
无院内死亡病例。所有行肠系膜血运重建优先策略的 4 例患者均无肠系膜缺血相关症状恢复。2 例行中央修复优先策略的患者出现麻痹性肠梗阻 1 周，其中 1 例需行剖腹探查术，但无患者需结肠切除术。
