Patients with type A acute aortic dissection presenting with major brain injury: Should we operate on them?

Eusanio, Marco Di; Patel, Himanshu J.; Nienaber, Christoph; Montgomery, Daniel; Korach, Amit; Sundt, Thoralf M.; Vincentiis, Carlo De; Voehringer, Matthias; Peterson, Mark D.; Myrmel, Truls; Folesani, Gianluca; Larsen, Marthe; Desai, Nimesh D.; Bavaria, Joseph E.; Appoo, Jehangir J.; Kieser, Teresa M.; Fattori, Rossella; Eagle, Kim A.; Bartolomeo, Roberto Di; Trimarchi, Santi

doi:10.1016/j.jtcvs.2012.11.054

Cited by 108 publications

(104 citation statements)

References 18 publications

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“…According to literature, the incidence of brain malperfusion ranges from 7% to 14% (29,30,32,33), and significantly affected the therapeutic management. IRAD data (33) showed that nearly 1 out of 10 TAAD patients are complicated by major brain injury at onset of dissection [cerebrovascular accident (CVA) 4.7%; coma 2.9%], carrying a two or threefold higher mortality depending on presence of CVA or coma respectively. Even in this cohort, surgery was found to be a protective factor against hospital mortality in patients with preoperative brain injury (OR, 0.058; P<0.001), although more than half of these patients do not still undergo TAAD repair.…”

Section: Resultsmentioning

confidence: 99%

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

Berretta¹,

Patel²,

Gleason³

et al. 2016

Ann. Cardiothorac. Surg.

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154

113

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Type A acute aortic dissection (TAAD) is a disease that has a catastrophic impact on a patient's life and emergent surgery represents a key goal of early treatment. Despite continuous improvements in imaging techniques, medical therapy and surgical management, early mortality in patients undergoing TAAD repair still remains high, ranging from 17% to 26%. In this setting, the International Registry of Acute Aortic Dissection (IRAD), the largest worldwide registry for acute aortic dissection, was established to assess clinical characteristics, management and outcomes of TAAD patients. The present review aimed to evaluate and comment on outcomes of TAAD surgery as reported from IRAD series.

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Section: Resultsmentioning

confidence: 99%

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

Berretta¹,

Patel²,

Gleason³

et al. 2016

Ann. Cardiothorac. Surg.

Self Cite

154

113

View full text Add to dashboard Cite

show abstract

“…(16,18). However, when assessing hospital outcomes according to therapeutic management the authors showed that medical therapy was associated with dismal outcomes: 100% mortality in patients with coma and 76.2% in those with cerebrovascular accident (17). However, surgery led to a hospital survival benefit of 49.6% in patients with preoperative neurologic symptoms and 55.6% of those with coma.…”

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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“…Cerebral malperfusion occurs in 6-14% of TAAD patients and results from partial or complete occlusion of the arch vessels by the intimal-medial flap, hypoxic encephalopathy secondary to shock or tamponade and/or brain embolism from thrombus in the false lumen ( Figure 2) (2)(3)(4)14,22). Clinical manifestations of stroke or coma were shown to be predictors for detrimental outcomes, and optimal management of TAAD patients with cerebral malperfusion syndrome remains controversial.…”

Section: Cerebral Malperfusionmentioning

confidence: 99%

Malperfusion syndromes in type A aortic dissection: what we have learned from IRAD

et al. 2018

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Patients presenting with type A acute aortic dissection (TAAD) complicated by malperfusion syndromes represent one of the highest surgical risk cohorts for cardiovascular surgeons. In the setting of aortic dissection, end-organ ischemia may involve any of the major arterial side branches resulting in myocardial, cerebral, spinal cord, visceral and/or limb ischemia. In TAAD patients with malperfusion, notwithstanding continuous improvement in diagnostic and management strategies, surgical and clinical outcomes remain poor and the optimal therapy is controversial. The present review aimed to assess current evidence on TAAD patients with the complication of malperfusion, as enunciated by the International Registry of Acute Aortic Dissection (IRAD) investigators.

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Patients with type A acute aortic dissection presenting with major brain injury: Should we operate on them?

Abstract: Brain injury at presentation adversely affects hospital survival of patients with type A acute aortic dissection. In the present observational study, the patients selected to undergo surgery demonstrated improved late survival and frequent reversal of neurologic deficits.

Cited by 108 publications

References 18 publications

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

Cerebral perfusion issues in type A aortic dissection

Malperfusion syndromes in type A aortic dissection: what we have learned from IRAD

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