Femoral Arterial Perfusion Guided by Intraoperative Transesophageal Echocardiography for Mesenteric Malperfusion in Acute Type A Aortic Dissection

Objectives: This study evaluated the outcomes of acute type A aortic dissection (ATAAD) complicated by mesenteric malperfusion managed with femoral arterial perfusion and intraoperative transesophageal echocardiography (TEE). Methods: We retrospectively reviewed 246 patients who underwent surgery for ATAAD between April 2011 and May 2022. Mesenteric malperfusion was identified in 8 of 49 patients (20%) with malperfusion syndrome. Femoral arterial perfusion was initiated to restore true lumen flow, and intraoperative TEE was used to assess abdominal aortic true lumen expansion and superior mesenteric artery (SMA) perfusion. Central aortic repair was performed after confirmation of mesenteric reperfusion. Results: Dynamic and static mesenteric obstructions were present in 5 and 3 patients, respectively. Femoral perfusion improved SMA flow in all dynamic cases and in 2 static cases. Seven patients (87.5%) survived to discharge; 1 patient with preoperative coma, shock, and static SMA obstruction died. In 1 patient with combined SMA and celiac artery obstruction, residual celiac malperfusion was not detected intraoperatively. Conclusions: Femoral arterial perfusion guided by intraoperative TEE is a feasible and effective strategy for mesenteric malperfusion in ATAAD. However, static branch obstruction and limitations of TEE warrant consideration of hybrid approaches.