Surgery for type A aortic dissection in patients with cerebral malperfusion: Results from the International Registry of Acute Aortic Dissection
Published on Nov 15, 2019in The Journal of Thoracic and Cardiovascular Surgery5.261
· DOI :10.1016/j.jtcvs.2019.11.003
Abstract Background The strategy for intervention remains controversial for patients presenting with type A aortic dissection (TAAAD) and cerebral malperfusion with neurologic deficit. Methods Surgically managed patients with TAAAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) were evaluated to determine the incidence and prognosis of patients with cerebral malperfusion. Results A total of 2402 patients underwent surgical repair of TAAAD. Of these, 362 (15.1%) presented with cerebral malperfusion (CM) and neurologic deficits and 2040 (84.9%) patients had no neurologic deficits (NCM) at presentation. Patients with CM were less likely to present with chest pain (66% vs 86.5%; p Conclusions Fifteen percent of patients with TAAAD presented with CM and neurologic deficits. Despite the fact that this subset of the population was older and more likely to present with peripheral malperfusion, cardiac tamponade, and in shock, in-hospital survival was noted in nearly 75% of the patients. Surgeons may continue to offer lifesaving surgery for TAAAD to this critically ill cohort of patients with acceptable morbidity and mortality.