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.