Application of the Branch-First Technique in Mesenteric Malperfusion Syndrome Prior to Delayed Open Aortic Repair for Acute Type A Aortic Dissection

Objective This study evaluated delayed open aortic repair (OAR) following interventional radiology (IR) in patients with acute type A aortic dissection (ATAAD) and mesenteric malperfusion syndrome (MeMPS), and identified clinical predictors of intestinal ischemia-related organ failure.Methods A retrospective analysis was conducted on 693 ATAAD patients (2018–2022). Thirty-seven hemodynamically stable MeMPS patients underwent upfront IR followed by delayed OAR. Controls were 656 ATAAD patients without malperfusion (Non-MPS) in any organ.Results The overall in-hospital mortality for MeMPS patients was 43.2% (16/37). 64.9% (24/37) of MeMPS patients survived initial IR and successfully underwent delayed OAR, achieving in-hospital mortality (12.5% vs. 8.2%, p = 0.714) and short-term survival comparable to those of Non-MPS patients. 35.1% (13/37) failed to undergo OAR following IR, primarily due to refractory organ failure (n = 10) or aortic rupture (n = 3). Reduced true lumen at diaphragm (Area Under Curve, AUC = 0.717), elevated fibrin degradation product (FDP) (AUC = 0.838), and D-dimer (AUC = 0.792) performed well in predicting intestinal ischemia-related organ failure.Conclusions For high-risk MeMPS patients, salvage IR effectively bridges to central repair with comparable in-hospital mortality and short-term survival to Non-MPS patients. The reduced true lumen at diaphragm, increased D-dimer and FDP are first identified as independent predictors of organ failure.