Revascularization and central repair procedure
Catheter IVR for mesenteric malperfusion was performed by radiologists. Percutaneous access to the mesenteric artery was obtained from a common femoral artery approach using a 6- or 7-Fr sheath. Lesions were crossed with a 0.035-inch, angle or straight, hydrophilic guidewire with or without a supporting 4-Fr straight catheter. Mesenteric lesions were treated with primary stenting using a self-expanding stent. Transesophageal echocardiography has been performed during IVR and central repair (Figure 1a); this modality enables evaluation of cardiac function, aortic valve regurgitation, and cardiac effusion, and moreover, it enables detection of whether the guidewire is placed in the true lumen or not during IVR.
Central aortic repair was performed through a median sternotomy using cardiopulmonary bypass with selective cerebral perfusion. Cardiopulmonary bypass was established with femoral artery and right axillar artery cannulation and bicaval venous drainage. After left ventricular venting, the patient was cooled down to 25°C. Then aortic arch repair for entry closure and true lumen reinstallation was performed. The replacement range was determined depending on the position of the entry. When aortic dissection extended to the aortic root and detachment of the aortic valve commissure occurred, the valvular resuspension technique was adopted.