INTRODUCTION
Over the past two decades, management of acute type A aortic dissection
(AAD) has markedly improved. However, mesenteric malperfusion is an
ominous complication carrying a higher risk of hospital
mortality.1 Appropriate management of this fatal
phenomenon remains controversial because of difficulty in obtaining
accurate diagnosis and providing prompt treatment.2, 3Previous reports proposed that central repair of entry closure and true
lumen reinstallation should be performed first for early survival
rate.4 However, recent results have reported
inconsistent results. According to Kamman, surgical delay due to
prioritizing release of ischemia is significantly associated with lower
mortality rates.3 Deeb et al. has demonstrated the
trend toward a better survival rate after endovascular perfusion repair
prior to cardiopulmonary bypass.5 With these results,
it is inferred that revascularization of mesenteric ischemia prior to
definitive aortic repair may improve outcomes. In our institution,
mesenteric revascularization with interventional radiology (IVR)
precedes central aortic repair for hemodynamically stable patients.
However, the appropriate strategy for hemodynamically unstable patients
is still controversial. The aim of this study is to present our
revascularization-first strategy and assess the postoperative results
for AAD involving mesenteric malperfusion.
Hybrid operation rooms (hybrid ORs) are currently gaining popularity
worldwide due to the exponential growth of endovascular aortic repair
and transcatheter aortic valve implantation procedures. Hybrid ORs have
enabled a variety of combined procedure including open surgical repair
and endovascular treatment. Tsagakis et al. advocated the Hybrid OR
concept to prioritize revascularization for ischemic organs even after
cardiac drainage.6, 7 Because the infinite
possibilities of the hybrid OR have been described,6,
7 we also conducted this study to investigate the utility of the hybrid
OR.