Surgical Results of Acute Aortic Dissection Complicated With Cerebral Malperfusion

Tanaka, Hiroshi; Okada, Kenji; Yamashita, Teruo; Morimoto, Yoshihisa; Kawanishi, Yujiro; Okita, Yutaka

doi:10.1016/j.athoracsur.2004.12.049

Cited by 77 publications

(67 citation statements)

References 9 publications

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“…Regarding the timing of surgery for AAAD, even in patients with CVD, the postoperative outcome was not affected by early operation [4] [7]. Moreover, some cases fully recovered by immediate surgery within 3 hour after ER arrival [5].…”

Section: Discussionmentioning

confidence: 91%

“…Poor prognostic factors after surgical treatment of AAAD include cardiopulmonary arrest [2], severe disturbance of consciousness [4], and cerebrovascular disorder [4] in the preoperative period. Emergency surgery in patients with those risk factors usually is avoided because of high mortality and morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Poor prognosis has been reported with cardiopulmonary arrest (CPA) [2], aortic branch occlusion [3] [4] [5] [6], severe consciousness disturbance [4], and cerebral vascular disorders (CVD) [4] in the preoperative period. We report a case of AAAD, requiring emergency surgery and recovering after out-of-hospital CPA with good neurological outcome.…”

Section: Introductionmentioning

confidence: 99%

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Recovery from Out-of-Hospital Cardiopulmonary Arrest Due to Type A Acute Aortic Dissection: A Case Report

Sugawara¹,

Kurihara²,

Ohtsubo³

et al. 2016

CRCM

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Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Computed tomography demonstrated type A acute aortic dissection (AAAD) with brachiocephalic artery occlusion. After admission, Glasgow Coma Scale score improved to E1VTM4, and voluntary movement was noted only in the right limbs. Outcome: The patient underwent emergency grafting of the ascending aorta and innominate artery under deep hypothermic circulatory arrest. After surgery, the patient recovered with mild disorientation and left hemiplegia. Magnetic resonance imaging of the head revealed no large infarction but revealed multiple acute ischemic changes. One year later, the patient demonstrated independent walk and successfully returned to work life. Conclusions: Immediate resuscitation and surgery resulted in good recovery from CPA after AAAD.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recovery from Out-of-Hospital Cardiopulmonary Arrest Due to Type A Acute Aortic Dissection: A Case Report

Sugawara¹,

Kurihara²,

Ohtsubo³

et al. 2016

CRCM

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“…Given the poor natural course of type A acute aortic dissection when complicated by cerebral malperfusion, 8 the decision to plan the reconstruction of the arch vessels is justified. 9 In conclusion, we believe that brachiocephalic artery reconstruction can be safely performed in a patient who presents with type A acute aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

Concomitant Reconstruction of Arch Vessels during Repair of Aortic Dissection

Mićović¹,

Nežić²,

Vuković³

et al. 2014

Texas Heart Institute Journal

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I n the presence of neurologic symptoms, surgical treatment of acute aortic dissection requires special attention. Whether repair of the ascending aorta needs to be supplemented by reconstruction of the arch vessels is still uncertain. There are few published papers 1,2 concerning the successful concomitant repair of arch vessels. Here we report the successful repair of a brachiocephalic artery, followed by reconstruction of the ascending aorta with the patient in profound hypothermia. Case ReportIn November 2012, a 40-year-old man was admitted to a regional hospital after the sudden onset of severe chest pain. An emergency-unit physician established a preliminary diagnosis of type A acute aortic dissection. Soon thereafter, the patient was transferred to our institution. At the time of admission, he was drowsy and reported right-hand numbness. No pulses were present in the right upper extremity, and the right carotid pulse was diminished. A bedside transthoracic echocardiogram confirmed the presence of an intimal flap in the ascending aorta. There were no signs of cardiac tamponade, and the patient was hemodynamically stable. We proceeded with an emergent 64-slice multidetector computed tomographic (MDCT) scan (Fig. 1), which showed type A acute aortic dissection with 3 intimal tears. One tear was at the left main coronary ostium, and the 2 others were at the level of the aortic arch-the second between the brachiocephalic and left carotid arteries, and the third below the left subclavian artery. The right subclavian artery was proximally occluded, and the flow in the right common carotid artery was diminished by false-lumen compression. The coronary arteries were free of disease.Our surgical plan was to reconstruct the brachiocephalic artery while the patient was cooling down in preparation for deep hypothermic circulatory arrest (DHCA). We established extracorporeal circulation via transventricular (apical) arterial and standard venous cannulation. We exposed the brachiocephalic artery in a usual manner (by means of a separate incision on the right side of the neck), and, as the patient's core temperature decreased to 22 °C, we constructed end-to-end anastomoses between branches of a bifurcated Y graft (12 × 6 mm) and the carotid and subclavian arteries. We then conducted the remnant of the Y graft into the anterior mediastinum, separately cannulated the arterial branches with intraluminal cannulas, and began antegrade cerebral perfusion (ACP) at a flow rate of 350 mL/min.During DHCA (54 min at 18 °C), a separate 30-mm Dacron graft was used for hemiarch reconstruction (the distal anastomosis having been secured by suturing the Case Reports

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“…126 However, whether the brain damage is reversible or irreversible should be determined with due caution. 127 (…”

Section: Aortic Dissectionmentioning

confidence: 99%

Guidelines for Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection (JCS 2011)

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2013

Circ J

257

101

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Surgical Results of Acute Aortic Dissection Complicated With Cerebral Malperfusion

Cited by 77 publications

References 9 publications

Recovery from Out-of-Hospital Cardiopulmonary Arrest Due to Type A Acute Aortic Dissection: A Case Report

Recovery from Out-of-Hospital Cardiopulmonary Arrest Due to Type A Acute Aortic Dissection: A Case Report

Concomitant Reconstruction of Arch Vessels during Repair of Aortic Dissection

Guidelines for Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection (JCS 2011)

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