Abstract
A 65-year-old man presenting with visceral malperfusion complicating acute type A aortic dissection underwent emergent surgery. Bypass grafting from the right common iliac artery to the superior mesenteric artery was performed prior to central aortic repair because intestinal ischemia caused hemodynamic instability. Subsequently, the ascending aorta was replaced with a Dacron graft under a condition of circulatory arrest with selective cerebral perfusion. Endotoxin adsorption was carried out intraoperatively in parallel with cardiopulmonary bypass to prevent postoperative end-organ failure. The patient recovered uneventfully and was discharged from our hospital 31 days after surgery.
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Fann JI, Sarris GE, Mitchell RS, Shumway NE, Stinson EB, Oyer PE, et al. Treatment of patients with aortic dissection presenting with peripheral vascular complications. Ann Surg 1990;212:705–713.
Apaydin AZ, Buket S, Posacioglu H, Islamoglu F, Calkavur T, Yagdi T, et al. Perioperative risk factors for mortality in patients with acute type A aortic dissection. Ann Thorac Surg 2002;74:2034–2039.
Deeb GM, Williams DM, Bolling SF, Quint LE, Monaghan H, Sievers J, et al. Surgical delay for acute type A dissection with malperfusion. Ann Thorac Surg 1997;64:1669–1675.
Di Luozzo G, Tannous HJ, Ellozy SH, Nowakowski S, Plestis KA, Adams DH, et al. Delayed repair of acute type A aortic dissection in a patient with gastrointestinal bleeding and pulse deficit. Ann Thorac Surg 2007;84:2097–2099.
Patel HJ, Williams DM, Dasika NL, Suzuki Y, Deeb GM. Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: a long-term analysis. J Thorac Cardiovasc Surg 2008;135:1288–1295.
Caty MG, Guice KS, Oldham KT, Remick DG, Kunkel SI. Evidence for tumor necrosis factor-induced pulmonary microvascular injury after intestinal ischemia-reperfusion injury. Ann Surg 1990;212:694–700.
Totsugawa T, Kuinose M, Yoshitaka H, Ishii S, Tsushima Y, Ishida A. Intraoperative endotoxin adsorption as a new therapeutic option for mycotic aortic aneurysm. Circ J 2008;72:161–163.
Rothenburger M, Soeparwata R, Deng MC, Berendes E, Schmid C, Tjan TD, et al. The impact of anti-endotoxin core antibodies on endotoxin and cytokine release and ventilation time after cardiac surgery. J Am Coll Cardiol 2001;38:124–130.
Sato H, Oshima K, Arakawa K, Kobayashi K, Yamazaki H, Suto Y, et al. Direct hemoperfusion with a polymyxin B-immobilized cartridge in intestinal warm ischemia reperfusion. World J Gastroenterol 2008;14:5436–5441.
Vincent JL, Laterre PF, Cohen J, Burchardi H, Bruining H, Lerma FA, et al. A pilot-controlled study of a polymyxin B-immobilized hemoperfusion cartridge in patients with severe sepsis secondary to intra-abdominal infection. Shock 2005;23:400–405.
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Totsugawa, T., Ozawa, M., Kuinose, M. et al. Intraoperative endotoxin adsorption for visceral malperfusion complicating acute type A aortic dissection. Gen Thorac Cardiovasc Surg 58, 134–137 (2010). https://doi.org/10.1007/s11748-009-0500-7
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DOI: https://doi.org/10.1007/s11748-009-0500-7