Comment
Rapid reestablishment of flow within the ascending aortic true lumen is
paramount in alleviating
dynamic malperfusion syndromes occurring in up to 90 % who sustain an
aortic dissection at the
time of aortic repair (1).
However, static and fixed malperfusion can persist despite aortic repair
of
dissection. If static malperfusion is not managed immediately, it can be
deadly regardless of
whether the malperfusion is addressed before or after aortic repair and
removal of an intimal tear
(2,3). We believe that malperfusion should be addressed simultaneously
at type A dissection
repair with growing advocacy (4,5). We modified our perfusion graft as
an alternative technique
(figure1) to perfuse both extremities and systemic circulation
expeditiously. This allowed
immediate reperfusion of the threatened limb during replacement of the
ascending thoracic
aortic, thereby limiting irreversible limb ischemia.