Application of the Branch-First Technique in Mesenteric Malperfusion Syndrome Prior to Delayed Open Aortic Repair for Acute Type A Aortic Dissection

This study evaluated delayed open aortic repair (OAR) following interventional radiology (IR) in patients with acute type A aortic dissection (ATAAD) and mesenteric malperfusion syndrome (MeMPS), and identified clinical predictors of intestinal ischemia-related organ failure.
A retrospective analysis was conducted on 693 ATAAD patients (2018–2022). Thirty-seven hemodynamically stable MeMPS patients underwent upfront IR followed by delayed OAR. Controls were 656 ATAAD patients without malperfusion (Non-MPS) in any organ.
The overall in-hospital mortality for MeMPS patients was 43.2% (16/37). 64.9% (24/37) of MeMPS patients survived initial IR and successfully underwent delayed OAR, achieving in-hospital mortality (12.5% vs. 8.2%, p = 0.714) and short-term survival comparable to those of Non-MPS patients. 35.1% (13/37) failed to undergo OAR following IR, primarily due to refractory organ failure (n = 10) or aortic rupture (n = 3). Reduced true lumen at diaphragm (Area Under Curve, AUC = 0.717), elevated fibrin degradation product (FDP) (AUC = 0.838), and D-dimer (AUC = 0.792) performed well in predicting intestinal ischemia-related organ failure.
For high-risk MeMPS patients, salvage IR effectively bridges to central repair with comparable in-hospital mortality and short-term survival to Non-MPS patients. The reduced true lumen at diaphragm, increased D-dimer and FDP are first identified as independent predictors of organ failure.
MeMPS patients who received interventional radiology followed by open aortic repair had better outcomes.

本研究评估了急性A型主动脉夹层（acute type A aortic dissection，ATAAD）合并肠系膜灌注不良综合征（mesenteric malperfusion syndrome，MeMPS）患者在接受介入放射学（interventional radiology，IR）治疗后行延期开放主动脉修复术（delayed open aortic repair，OAR）的疗效，并明确了肠缺血相关性器官衰竭的临床预测因素。
本研究对2018至2022年间的693例ATAAD患者开展回顾性分析。其中37例血流动力学稳定的MeMPS患者先行IR治疗，随后接受延期OAR；对照组为656例无任何器官灌注不良的ATAAD患者（Non-MPS组）。
MeMPS患者的整体住院死亡率为43.2%（16/37）。64.9%（24/37）的MeMPS患者在初始IR治疗后存活，并成功接受延期OAR，其住院死亡率（12.5% vs. 8.2%，p=0.714）及短期生存率与Non-MPS组患者相当。35.1%（13/37）的患者在IR治疗后未能接受OAR，主要原因为难治性器官衰竭（n=10）或主动脉破裂（n=3）。膈肌水平真腔缩小（受试者工作特征曲线下面积（Area Under Curve，AUC）=0.717）、纤维蛋白降解产物（fibrin degradation product，FDP）升高（AUC=0.838）及D-二聚体升高（AUC=0.792）可有效预测肠缺血相关性器官衰竭。
对于高危MeMPS患者，补救性IR治疗可有效桥接至中心主动脉修复术，其住院死亡率及短期生存率与Non-MPS组患者相当。本研究首次明确膈肌水平真腔缩小、D-二聚体及FDP升高是器官衰竭的独立预测因子。
接受介入放射学治疗联合开放主动脉修复术的MeMPS患者预后更佳。