Study population
Diagnosis was confirmed using computed tomography (CT) in our hospital
or other previous hospitals. Mesenteric malperfusion was defined as
symptoms associated with mesenteric ischemia or severely impaired
perfusion of the superior mesenteric artery (SMA) because of the extent
of dissection. Mesenteric ischemia was characterized by abdominal
symptoms including abdominal pain or vomiting, and the presence of
metabolic acidosis including elevated lactate or decreased base excess.
Demographics (age and sex), comorbidities (hypertension, chronic
respiratory disease, chronic renal disease, diabetes mellitus, smoking
history, and family history related to aortic dissection), and specific
preoperative complications related to aortic dissection (other-organ
malperfusion, aortic valve regurgitation, cardiac tamponade, shock
hemodynamics, cardiac arrest, and resuscitation) were recorded.
Revascularization for mesenteric ischemia was basically prioritized in
cases with mesenteric malperfusion; however, in cases with hemodynamic
instability due to cardiac tamponade or free rupture, central aortic
repair was prioritized. In cases with other-major organ malperfusion,
that is, cardiac or cerebral malperfusion, revascularization for these
organs is preceded first. The priority of the strategy was discussed by
the aortic team composed of surgeons, anesthesiologists, and
radiologists.