Management of cerebral malperfusion in surgical repair of acute type A aortic dissection

Furukawa, Toshiyuki; Uchida, Naoshige; Takahashi, Shinya; Yamane, Yasuo; Mochizuki, Seibu; Yamada, Kazunori; Mochizuki, Takashi; Sueda, Taijiro

doi:10.1093/ejcts/ezx056

Cited by 34 publications

(37 citation statements)

References 20 publications

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“…In Table 1, it summarized observational single center experience focusing on neurological outcomes after TAAAD (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Resultsmentioning

confidence: 99%

Cerebral perfusion issues in type A aortic dissection

et al. 2018

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Stroke events are very common in acute type A aortic dissection. Cerebral malperfusion could manifest at presentation due to prolonged arch vessels hypoperfusion or develop after surgery for inadequate cerebral protection during arch repair. To reduce this detrimental complication there are several adjuncts that can be adopted for cerebral protection such as direct antegrade or retrograde cerebral perfusion (RCP) and use period of deep to moderate hypothermic circulatory arrest time; however, they are often insufficient as preoperative malperfusion already caused irreversible ischemic damages. The aim of the current review article is to analyze the principal series reporting on neurological injuries during type A aortic dissection to focus on the outcomes according to the type of surgical management and identify possible predictors to better manage this complication.

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“…In Table 1, it summarized observational single center experience focusing on neurological outcomes after TAAAD (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Resultsmentioning

confidence: 99%

Cerebral perfusion issues in type A aortic dissection

et al. 2018

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“…Furukawa et al reported that partial or complete thrombosis of the supra-aortic branch vessels is an independent risk factor of perioperative cerebral malperfusion. 16) Most patients in the young group had completely patent false lumen. Thus, the incidence of cerebral malperfusion due to thrombosis at the false lumen of the supra-aortic branch vessels is low.…”

Section: Discussionmentioning

confidence: 96%

“…The rate of TAR was equal or higher than that in previous reports (15%-48%). 1,2,[13][14][15][16] However, whether extensive aortic replacement should be performed in the emergency setting still remains controversial. Di Eusanio et al reported that TAR is one of the independent risk factors for in-hospital mortality on the basis of the complete International Registry of Aortic Dissection (IRAD) database (1,995 surgery patients from January 1996 to January 2013).…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Surgical Results of Acute Type A Aortic Dissection in Patients Younger Than 50 Years of Age

Tamura

Chikazawa

Hiraoka

et al. 2019

Annals of Vascular Diseases

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The aim of this study is to investigate the characteristics and surgical outcomes of acute type A aortic dissection (AAAD) in patients younger than 50 years of age. Methods: We retrospectively evaluated 307 patients who consecutively underwent surgical treatment for AAAD in our institute from January 2007 to June 2017. Patients were classified into two groups: the young group with 31 patients aged younger than 50 and the old group with 276 patients aged 50 years or older. Results: In-hospital mortality was similar in both groups (3.2% vs. 9.4%, p=0.19). Overall survival at 5 years was higher in the young group than that in the old group (97% vs. 71%, p=0.017). No significant differences were observed in freedom from aorta-related death and distal aortic reoperation at 5 years (97% vs. 87%, p=0.26; 86% vs. 92%, p=0.093). The percentage of young patients with postoperative patent false lumen at the descending aorta was significantly higher than that of old patients (76% vs. 30%, p<0.001) in spite of primary entry resection. Conclusion: Early and mid-term outcomes for AAAD in young patients were satisfactory. However, future follow-up is important because postoperative patent false lumen is at a high rate in young patients in spite of entry resection.

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“…and (3) available postoperative brain CT data. Exclusion criteria included (1) previous aortic surgical history (n = 16); (2) history of old cerebral infarction or hemorrhagic stroke (n = 7); (3) unevaluable CTA images (n = 7); (4) interval from admission to surgery of > 24 hours (n = 31); (5) without preoperative DWI examination (n = 76); and (6) postoperative nonneurogenic death (n = 12). A total of 149 patients were excluded.…”

Section: Patientsmentioning

confidence: 99%

“…[1] Despite numerous innovations in contemporary perioperative anesthetic and surgical management, stroke after surgical treatment of ATAAD remains high, ranging from 2.9-30.4% in published series. [2][3][4][5][6][7][8] Previous reports described that preoperative cerebral malperfusion in patients with ATAAD is a predictor for postoperative stroke and detrimental outcome. [9][10][11] Cerebral malperfusion was diagnosed if patients with ATAAD had neurological symptoms and signs with ultrasonography or radiographic evidence of dissection of the corresponding aortic branch vessel.…”

Section: Introductionmentioning

confidence: 99%

Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

Zhao

Guo

et al. 2020

Preprint

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Background Stroke is a common postoperative complication in patients with acute type A aortic dissection (ATAAD). We aimed to explore the preoperative imaging risk findings for postoperative new stroke in patients with ATAAD. Methods From January 2015 to December 2018, 174 patients with ATAAD who underwent preoperative aortic computed tomography angiography (CTA) and cerebral diffusion-weighted imaging (DWI) as well as postoperative brain CT were included, and divided into DWI (+) and DWI (-) groups. Pre- and intraoperative variables were collected, and logistic regression analysis was used to determine the independent risk predictors of postoperative new stroke. Results The incidence of postoperative new stroke was 18.4% (32/174) in patients with ATAAD. Postoperative stroke was detected in 13 (31.0%) patients in the DWI (+) group and in 19 (14.4%) patients in the DWI (-) group with significant difference (P = 0.016). In the DWI (+) group, the lesions of the cerebral infarction located in the unilateral cerebral hemisphere and distributed more than three lobes (P = 0.007) were an independent risk factor for postoperative new stroke. Hypotension (P = 0.002), retrograde ascending aorta dissection with thrombosis of the false lumen (P = 0.010), aortic arch entry (P = 0.035), and coronary artery involvement (P = 0.001) were independent risk factors for postoperative stroke in the DWI (-) cohort. Conclusions Patients with ATAAD with cerebral infarction are more likely to develop postoperative new stroke; thus, a preoperative DWI examination may be necessary. DWI lesions distributed more than 3 lobes in the unilateral hemisphere suggest a high possibility of postoperative stroke. For patients with ATAAD with normal brain, particular attention should be given to the CTA findings of false lumen thrombosis, aortic arch entry, and coronary artery involvement to avoid postoperative stroke. Trial registration: Retrospectively registered.

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Management of cerebral malperfusion in surgical repair of acute type A aortic dissection

Abstract: Perioperative cerebral perfusion should be carefully managed, especially in the patients with preoperative neurological symptoms or partial or complete thrombosis of the SABV.

Cited by 34 publications

References 20 publications

Cerebral perfusion issues in type A aortic dissection

Cerebral perfusion issues in type A aortic dissection

Characteristics and Surgical Results of Acute Type A Aortic Dissection in Patients Younger Than 50 Years of Age

Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

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