title: Treatment strategy for acute type a aortic dissection complicated with organ ischemia.
abstract: OBJECTIVE
  We report our current treatment strategy for acute type A aortic dissection with organ ischemia as well as notable findings in our experience.
  
  
  METHODS
  Among 101 cases of acute type A aortic dissection, 25 had organ ischemia. Malperfusion was assessed at the aorta, proximal portion of the branch, organ parenchyma, and organ function by means of multiple modalities, including transesophageal echocardiography (TEE), near-infrared spectroscopy, and physical examinations. It was assessed every time the perfusion status was altered.
  
  
  RESULTS
  There were three operative deaths and one late hospital death. Uncertainty of symptoms and inadequate preoperative assessment in an emergent situation indicated the necessity of an overall check-up of organ ischemia in the operating room on a routine basis. Multi-modality assessment including TEE was helpful for this purpose. Two cases indicated that recovery of a true lumen could be inadequate despite true lumen perfusion including central cannulation. Thrombus in the false lumen appeared to be responsible.
  
  
  CONCLUSIONS
  To solve practical problems in treating acute type A dissection with organ ischemia, real-time information on organ perfusion is important for detecting the presence of malperfusion, making an appropriate strategy, and immediately assuring the efficacy of the means taken.
authors.affiliation: Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Orihashi
authors.forename: Masamichi
authors.initials: M
authors.lastname: Ozawa
authors.forename: Shinya
authors.initials: S
authors.lastname: Takahashi
authors.forename: Taiichi
authors.initials: T
authors.lastname: Takasaki
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Sato
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kurosaki
authors.forename: Bagus
authors.initials: B
authors.lastname: Herlambang
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Imai
authors.forename: Taijiro
authors.initials: T
authors.lastname: Sueda
keywords: aortic dissection; echocardiography; malperfusion; near-infrared spectroscopy; surgery
references.citation: Ann Thorac Surg. 2001 Feb;71(2):673-7
references.pmid: 11235726
references.citation: Circulation. 2002 Jan 15;105(2):200-6
references.pmid: 11790701
references.citation: JAMA. 2000 Feb 16;283(7):897-903
references.pmid: 10685714
references.citation: Arch Intern Med. 2000 Oct 23;160(19):2977-82
references.pmid: 11041906
references.citation: J Cardiothorac Vasc Anesth. 2006 Feb;20(1):20-5
references.pmid: 16458208
references.citation: J Vasc Surg. 1988 Feb;7(2):199-209
references.pmid: 3276932
references.citation: Eur J Cardiothorac Surg. 2005 Dec;28(6):871-6
references.pmid: 16275006
references.citation: J Thorac Cardiovasc Surg. 1998 Apr;115(4):945-7
references.pmid: 9576233
references.citation: Eur J Cardiothorac Surg. 1995;9(5):242-6; discussion 247
references.pmid: 7544988
references.citation: Ann Surg. 1990 Dec;212(6):705-13
references.pmid: 2256762
references.citation: J Thorac Cardiovasc Surg. 2000 Sep;120(3):466-72
references.pmid: 10962406
references.citation: Eur J Cardiothorac Surg. 2004 Nov;26(5):907-11
references.pmid: 15519181