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.