Aorto–Superior Mesenteric Artery Bypass in Type A Aortic Dissection Complicated by Mesenteric Malperfusion: Reperfusion-First Strategy

Mesenteric malperfusion represents one of the most fatal complications associated with acute aortic dissection. We successfully treated a patient with complicated type A aortic dissection and superior mesenteric artery (SMA) obstruction. Before central aortic repair, a 6-mm ringed expanded polytetrafluoroethylene graft was anastomosed to the SMA to achieve initial reperfusion of ischemic mesentery. Central aortic repair was performed under circulatory arrest with the support of cardiopulmonary bypass. The inflow of the graft was redirected to the side branch of the quadrifurcated graft, thus effectively establishing the aorto-superior mesenteric artery bypass. This reperfusion-first strategy proves to be safe and beneficial in patients with mesenteric malperfusion.