Kyobu geka. The Japanese journal of thoracic surgery
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Mesenteric ischemia is a dreaded complication of acute type A aortic dissection. From January 1994 to December 2004, 134 patients with acute type A aortic dissection were operated. Eleven patients showed postoperative mesenteric ischemia. ⋯ Our strategy to manage these patients is as follows; patients who are suffering mesenteric and/or lower extremity ischemia preoperatively, or those whose computed tomography (CT) shows stenosis, obstruction, or dissection of the superior mesenteric artery, should be recognized as high-risk patients of postoperative mesenteric ischemia. Their mesenteric circulation should be examined directly with laparotomy after the central repair. If the mesenteric circulation seems to be suboptimal, iliac artery-superior mesenteric artery bypass should be performed.
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From June 2003 to November 2006, transapical aortic cannulation was performed in 73 patients (41 men and 32 women, mean age 63 years, 64 hemiarch repair and 9 total arch replacement) with acute type A aortic dissection. A 1-cm incision was made in the apex of the left ventricle, and a 7-mm soft and flexible cannula was passed through the apex and across the aortic valve until positioned in the ascending aorta under guidance by transesophageal echocardiography. ⋯ There were no malperfusion events. Our results showed that transapical aortic cannulation was secure and useful for repair of acute type A aortic dissection.