Purpose: Approximately one third of patients with Acute Type A Aortic Dissection (ATAAD) present with pre-operative malperfusion syndromes (MPS). Of these, mesenteric malperfusion represents the greatest risk to patients with a short-term mortality. In select patients, it may be feasible to offer a staged approach by treating the mesenteric malperfusion first, optimizing the patient in the intensive care setting and then, following with a central aortic repair. Methodology: An electronic literature search of five databases was performed to identify all relevant studies providing studies providing short-term mortality on patients who underwent either endovascular or open revascularisation of mesenteric ischemia prior to central aortic repair. The primary outcome was all cause short-term mortality. Secondary outcomes were comparative mortality between a delayed repair vs aortic repair first strategy, rates of postoperative laparotomy or bowel resection and mortality following delayed aortic repair. Results: The search strategy identified 8 studies qualifying for inclusion, with a total of 180 patients who underwent delayed aortic surgery in the setting of mesenteric MPS. The weighted short-term mortality following a mesenteric revascularisation first, delayed aortic surgery strategy was 22.5%. This strategy was also associated with a significantly lower mortality than a central repair first strategy (OR 0.07, 95% CI 0.02 – 0.27), significantly lower rate of postoperative laparotomy/bowel resection (OR 0.05, 95%CI 0.02 – 0.14). If patients survive to receive central repair, the weighted short-term mortality postoperatively is low (2.1%) Conclusion A summary of this evidence reveals a lower short-term mortality in hemodynamically stable patients with mesenteric malperfusion, along with a reduction in postoperative laparotomy/bowel resections. Further high-quality studies with randomized or propensity matched data are required to verify these results.