[Treatment for Stanford Type A Acute Aortic Dissection with Malperfusion].

Abstract

Background: For malperfusion in Stanford type A acute aortic dissection, we resolve static intestinal ischemia prior to central repair, rapidly unload the left ventricle for myocardial ischemia, and resolve cerebral or lower limb ischemia using cardiopulmonary bypass, We evaluated the validity of this strategy, Subjects:Among 165 emergency surgeries for Stanford type A acute aortic dissection performed since 2009, malperfusion was present in 52 cases(brain 23/heart 9/kidney 8/intestine 4/lower extremity 21)[overlap present], Results:Mean age was 63±12 years;29 patients were male;1 case had Marfan syndrome, The median time from onset to extracorporeal circulation initiation was 5 hours(range 2~51), Postoperative extracorporeal membrane oxygenation(ECMO)was used in 5 cases;in-hospital mortality occurred in 8 cases;and 8 cases had residual sequelae of cerebral infarction(controlled reperfusion in 1), Conclusion:Strategies for treating coronary malperfusion require improvement, In cerebral malperfusion, controlled reperfusion may be effective, with fewer residual sequelae in treated cases.