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J Thorac Cardiovasc Surg 2009;138:306-308
© 2009 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Eric Roselli, MD (Cleveland, Ohio). Congratulations on a fine presentation and an outstanding experience. Dr Patel and I did some of our endovascular training together under the leadership of Roy Greenberg, who apologizes for not being here today, but he and I reviewed the article together and compiled the following questions and observations.

Dr Patel and colleagues at the University of Michigan have provided us with a relatively large amount of long-term data regarding a technique used to treat malperfusion syndrome after acute distal dissection. Dr Williams and his counterparts have long been considered the pioneers of these complex interventional techniques, and their expertise in aortic flap fenestrations is likely unparalleled. However, several fundamental questions are raised by both the implementation of such a treatment strategy and the extended follow-up data you have provided.

Would you please clarify your patient population? Malperfusion is really a clinical syndrome rather than a radiographic diagnosis, yet in your series you included patients with a clinical syndrome and evidence of true lumen collapse by computed axial tomography scan. Can you segregate your results to provide us with the number of patients treated solely on the basis of radiographic evidence of true lumen collapse or ischemia versus those with clinical evidence of this complication along with their respective outcomes?

Dr Patel. You are absolutely correct in that there is a difference between radiographic findings and presentation with a syndrome of end-organ dysfunction. We completely agree with that. The latter, the syndrome of end-organ dysfunction, results from prolonged ischemia, and at our center, because of the availability of these interventional techniques, we have taken an aggressive stance in studying patients who present with angiographic or CT findings to prevent the subsequent development of end-organ failure from prolonged ischemia.

We did perform the analysis that you . . . [Full Text of this Article]