Eastern Cardiothoracic Surgical Society

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MANAGEMENT OF TYPE A AORTIC DISSECTION WITH ASSOCIATED MALPERFUSION SYNDROME: CASE REPORT
Morgan K. Moroi1, Brandon S. Hendriksen2, Michael Roberts3, Maria C. Castello Ramirez4, Kaushik Mandal2.
1Penn State College of Medicine, Hershey, PA, USA, 2Division of Cardiac Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA, 3Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA, 4Division of Vascular and Endovascular Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.

OBJECTIVE: Acute type A aortic dissection (TAAD) with malperfusion syndrome remains a challenging case as optimal surgical management remains unsettled (immediate proximal arch repair versus immediate endovascular organ reperfusion with delayed aortic repair).
METHODS: We present two cases of TAAD with malperfusion syndrome and their employed surgical approaches.
RESULTS: Case 1: A 63-year-old man presented with chest pain, syncope, and pulseless bilateral lower extremities. Computed tomography (CT) scanning showed TAAD complicated by hemopericardium and decreased blood flow below the level of the superior mesenteric artery. In the operating room, an aortic hemiarch repair was performed using a 34-mm Valsalva Gelweave graft. A right axillary-bifemoral 9-mm polytetrafluoroethylene graft was utilized to restore lower body perfusion. Case 2: A 61-year-old man presented with chest pain radiating to his back and no palpable pulse in the left radial artery. CT scanning revealed TAAD extending into the brachiocephalic, left subclavian, and bilateral iliac arteries. A hemiarch repair was completed using a 28-mm Hemashield graft, and this repair restored flow to the left upper extremity.
CONCLUSIONS: With early multidisciplinary collaboration, satisfactory outcomes can be achieved in patients with TAAD with malperfusion syndrome through urgent repair of the aorta and simultaneous efforts to restore blood flow to ischemic peripheral tissue.


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