{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:01:05Z","timestamp":1790715665618,"version":"4.1.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute type A aortic dissection (ATAAD) complicated by mesenteric malperfusion is among the most lethal cardiovascular emergencies, combining the immediate threat of aortic rupture with rapidly progressive visceral ischaemia. The optimal sequence of intervention remains controversial. Although current guidelines recommend immediate central aortic repair, this strategy may carry particularly high perioperative risk when advanced mesenteric ischaemia is already present.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 54-year-old woman with no relevant medical history presented with ATAAD extending from the sinotubular junction to the iliac bifurcation, complicated by severe mesenteric malperfusion and haemodynamic instability. Following urgent multidisciplinary discussion, a staged strategy was adopted. On Day 0, visceral reperfusion was achieved by iliac-to-superior mesenteric artery bypass with concomitant exploratory laparotomy, combined with thoracic endovascular aortic repair. Progressive intestinal ischaemia over the next 48\u2005h required multiple abdominal surgeries, including right colectomy, left colectomy with ileosigmoidostomy, and cholecystectomy, until bowel viability was controlled. Definitive total aortic arch replacement using a Thoraflex hybrid prosthesis was then performed on Day 6 under cardiopulmonary bypass with brief circulatory arrest. Despite a prolonged and complex postoperative course, the patient survived to hospital discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case illustrates the multidisciplinary decision-making involved in the management of a highly selected patient with ATAAD and established severe mesenteric malperfusion syndrome, in whom the immediate risk of visceral ischaemia was weighed against the substantial risk of delaying central repair.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag693","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T11:44:48Z","timestamp":1789213488000},"source":"Crossref","is-referenced-by-count":0,"title":["Staged visceral revascularization prior to central aortic repair in acute type A aortic dissection complicated by mesenteric malperfusion: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8834-2488","authenticated-orcid":false,"given":"Georges","family":"Abi Abdallah","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Critical Care & Perioperative Medicine, AP-HP, H\u00f4pital Europ\u00e9en Georges Pompidou , 20 rue Leblanc, 75015 Paris ,","place":["France"]},{"name":"Universit\u00e9 Paris Cit\u00e9, Inserm, PARCC, UMR_S970 , 56 rue Leblanc, 75015 Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8718-9218","authenticated-orcid":false,"given":"Francesca","family":"Pitocco","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, Inserm, PARCC, UMR_S970 , 56 rue Leblanc, 75015 Paris ,","place":["France"]},{"name":"Department of Radiology, H\u00f4pital Europ\u00e9en Georges Pompidou, Assistance Publique H\u00f4pitaux de Paris , 20 rue Leblanc, 75015 Paris 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AP-HP, H\u00f4pital Europ\u00e9en Georges Pompidou , 20 rue Leblanc, 75015 Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6606-1263","authenticated-orcid":false,"given":"Lena","family":"Ple-Nemo","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Critical Care & Perioperative Medicine, AP-HP, H\u00f4pital Europ\u00e9en Georges Pompidou , 20 rue Leblanc, 75015 Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2643-0905","authenticated-orcid":false,"given":"Maxime","family":"Renaux","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Critical Care & Perioperative Medicine, AP-HP, H\u00f4pital Europ\u00e9en Georges Pompidou , 20 rue Leblanc, 75015 Paris 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