ICU Controlled Delay for Acute Type A Aortic Dissection Repair after Intervention for Total Visceral Malperfusion: A Way Out of a Dilemma?

Introduction

The prognosis for surgical repair of acute type A aortic dissection is mainly influenced by the presence of malperfusion. Visceral malperfusion certainly is associated with a grim prognosis. Rapid restoration of flow into the true lumen is one way to deal with this problem, primary restoration of abdominal perfusion using interventional fenestration or stenting another [[1], [2], [3]]. With the advent of a hybrid room integrating an angiography unit into a fully equipped operating room, for the first time it is possible to obtain immediate “on-table” information about the abdominal perfusion situation so that decisions are no longer based on hours old CT scans or mere clinical judgement. Whether or not this information warrants immediate surgical reaction is discussed below, based on two case reports.

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