Stroke in surgery of the thoracic aorta: Incidence, impact, etiology, and prevention

Abstract

(1) Stroke complicates surgery of both the ascending and descending thoracic aorta and warrants consideration in decision making. (2) Strokes are largely embolic. (3) Antiembolic measures for particles and air are essential, including gentle aortic manipulation, thorough debridement, transesophageal echocardiography to identify aortic atheromas, carbon dioxide flooding of the field, and (in descending cases) proximal clamp application before initiating femoral perfusion.

Diretrizes para a cirurgia das doenças da aorta

“…Além disso, a curva da sobrevida em 5 anos dos pacientes com diâmetro > 6cm foi de apenas 56% em 5 anos, e de 85% para casos operados eletivamente (p=0,003), sobrevida semelhante à encontrada na população normal, com mesma idade média. Esses achados, associados à mortalidade operatória de 11% apresentada pelo grupo 144 , têm levado os autores a arbitrarem em 6cm o parâmetro de indicação cirúrgica para AAD, conduta considerada consensual pelos especialistas 23 .…”

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…30 The presence of stroke after DTA surgery seems to be similar to aortic arch repair and often has an embolic aetiology, with an incidence up to 8% in elective cases or higher in the emergency setting. 31 Classic predictors for these complications are diverse and include increasing patient age, previous carotid artery disease, aortic cross-clamp time, the extent of the aortic resection, aortic rupture, concurrent aneurysm disease of ascending aorta and/or aortic arch, emergency surgery, the use and duration of hypothermic arrest, peri-operative hypotension, and pre-operative renal dysfunction.…”

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

“…However, the retrograde blood stream sometime causes serious complications. 6,7) On the other hand, the axillary artery is favored by many surgeons as an alternative cannulation site with the aim of avoiding cerebral atheroembolization, in order to prevent an extension of dissection, which can result in malperfusion, and to facilitate antegrade cerebral perfusion. However, this technique is time consuming and not always safe or reliable.…”

“…However, the retrograde blood stream sometime causes serious complications, such as cerebral embolism and organ malferfusion. 6,7) On the other hand, axillary artery has been used for cannulation site by many surgeons. However, this technique is time consuming and not always safe or reliable.…”