The First Clinical Medical College of Gannan Medical University, Ganzhou, 341000, China.
First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China.
J Cardiothorac Surg. 2024 May 11;19(1):286. doi: 10.1186/s13019-024-02790-z.
Acute type A aortic dissection is a severe cardiovascular disease characterized by rapid onset and high mortality. Traditionally, urgent open aortic repair is performed after admission to prevent aortic rupture and death. However, when combined with malperfusion syndrome, the low perfusion of the superior mesenteric artery can further lead to intestinal necrosis, significantly impacting the surgery's prognosis and potentially resulting in adverse consequences, bringing. This presents great significant challenges in treatment. Based on recent domestic and international research literature, this paper reviews the mechanism, current treatment approaches, and selection of surgical methods for poor organ perfusion caused by acute type A aortic dissection. The literature review findings suggest that central aortic repair can be employed for the treatment of acute type A aortic dissection with inadequate perfusion of the superior mesenteric artery. The superior mesenteric artery can be windowed and (/or) stented, followed by delayed aortic repair. Priority should be given to revascularization of the superior mesenteric artery, followed by central aortic repair. During central aortic repair, direct blood perfusion should be performed on the distal true lumen of the superior mesenteric artery, leading to resulting in favorable therapeutic outcomes. The research results indicate that even after surgical aortic repair, intestinal ischemic necrosis may still occur. In such cases, prompt laparotomy and necessary necrotic bowel resection are crucial for saving the patient's life.
急性 A 型主动脉夹层是一种严重的心血管疾病，其特点是发病迅速、死亡率高。传统上，患者入院后会立即进行紧急开放式主动脉修复手术，以防止主动脉破裂和死亡。然而，当合并灌注不良综合征时，肠系膜上动脉的低灌注会进一步导致肠坏死，严重影响手术预后，并可能导致不良后果。这给治疗带来了巨大的挑战。基于最近国内外的研究文献，本文回顾了急性 A 型主动脉夹层导致的器官灌注不良的机制、当前治疗方法和手术方法的选择。文献回顾的结果表明，对于肠系膜上动脉灌注不足的急性 A 型主动脉夹层，可以采用中心主动脉修复治疗。可以对肠系膜上动脉开窗和/或支架置入，然后再进行延迟的主动脉修复。应优先考虑肠系膜上动脉的血运重建，然后再进行中心主动脉修复。在中心主动脉修复过程中，应直接对肠系膜上动脉的远端真腔进行血运重建，从而获得良好的治疗效果。研究结果表明，即使在手术后进行了主动脉修复，仍可能发生肠缺血性坏死。在这种情况下，及时进行剖腹手术和必要的坏死肠段切除对挽救患者生命至关重要。
