The surgical management of preoperative malperfusion poses considerable challenges, particularly in cases of acute type A aortic dissection (TAAD). Herein, we describe the case of a 78-year-old female patient presenting with TAAD complicated by malperfusion of the left lower extremity and an entry tear localized to the ascending aorta. During the initiation of cardiopulmonary bypass (CPB), a pronounced bilateral discrepancy in radial mean arterial blood pressure (mABP) was identified, alongside a significant reduction in cerebral tissue oxygenation index (TOI) and the oxyhemoglobin change rate (ΔHbO2). To mitigate the malperfusion, pulsatile flow (PF) was utilized during CPB. This report elucidates the meticulous application of PF during CPB in the management of this complex malperfusion scenario, culminating in a favorable postoperative outcome.
Keywords: Aortic dissection; Malperfusion; Near-infrared spectroscopic oximetry (NIRO); Pulsatile flow.
© The Author(s), published by EDP Sciences, 2025.