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Management of Malperfusion Syndrome in Acute Type A Aortic Dissection

  • Hiroto Kitahara
  • Akiko Tanaka
  • Takeyoshi OtaEmail author
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

Malperfusion is one of the most devastating complications of acute type A aortic dissection (ATAAD) that significantly affects clinical outcomes. If malperfusion is not corrected in a timely manner, organ ischemia may progress to irreversible dysfunction (i.e. infarction), called malperfusion syndrome. Malperfusion could affect any organ in the body including heart, brain, spinal cord, viscera, and limbs. It has been under debate if endovascular or surgical intervention for peripheral reperfusion to treat symptomatic malperfusion should be performed prior to central surgical repairs, or vice versa. Optimal surgical strategy of ATAAD with malperfusion should be determined case-by-case basis depending on a variety of factors including which organs are involved, the degree of end organ impairment, and most importantly, elapsed time since onset. Progressive technology would change patient management and help to improve clinical outcomes. Recently, hybrid suites have become available and found useful for simultaneous early diagnostic investigation as well as therapeutic intervention for ATAAD patients with malperfusion. Hybrid surgical approaches such as the frozen elephant trunk technique also show promising outcomes for ATAAD with malperfusion. In this section, classic and latest management of malperfusion of each affected organ in ATAAD patients will be reviewed.

Keywords

Acute type A aortic dissection Malperfusion Endovascular intervention Frozen elephant trunk technique 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Surgery, Section of Cardiac and Thoracic SurgeryThe University of ChicagoChicagoUSA
  2. 2.Department of Cardiothoracic and Vascular SurgeryMcGovern Medical School at UTHealthHoustonUSA

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