Cerebral perfusion issues in type A aortic dissection

Pacini, Davide; Murana, Giacomo; Marco, Luca Di; Berardi, Marianna; Mariani, Carlo; Coppola, Giuditta; Fiorentino, Mariafrancesca; Leone, Alessandro; Bartolomeo, Roberto Di

doi:10.21037/jovs.2018.03.20

Cited by 20 publications

(25 citation statements)

References 30 publications

(34 reference statements)

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“…Evaluation of preoperative risk factors for postoperative stroke based on imaging information is also accurate. In this study, preoperative acute cerebral infarction resulting from cerebral hypoperfusion is frequent and is found in 24.1% of the brains, which is higher than the results in previous studies (17)(18)(19). This may be related to the fact that the majority of the patients with ATAAD in this study had neurological symptoms and signs.…”

Section: Discussioncontrasting

confidence: 67%

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

Zhao

Guo

et al. 2020

Front. Cardiovasc. Med.

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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.

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Section: Discussioncontrasting

confidence: 67%

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

Zhao

Guo

et al. 2020

Front. Cardiovasc. Med.

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show abstract

“…In this study, preoperative acute cerebral infarction resulting from cerebral hypoperfusion is frequent and is found in 24.1% of the brains, which is higher than the results in previous studies. [17][18][19] This may be related to the fact that the majority of the patients with ATAAD in this study had neurological symptoms and signs. Our results, showing a percentage of 18.4% of postoperative stroke in patients with ATAAD, are similar to those reported in a previous study.…”

Section: Discussionmentioning

confidence: 86%

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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“…The recommended ASCP rate was 10–15 ml/kg per min and the bilateral cerebral perfusion rate was 20–30 ml/kg per min. 24,25 Before CA was commenced, the axillary perfusion accounted for one-third of the total perfusion. During lower body CA, ASCP, which was total flow, was continuously set at 10–15 ml/kg per min and the femoral perfusion was clamped.…”

Section: Discussionmentioning

confidence: 99%

The strategy of cardiopulmonary bypass for total aortic arch replacement and the frozen elephant trunk technique with aortic balloon occlusion

Yan

Lou

et al. 2020

J Int Med Res

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Objective To investigate the use of the aortic balloon occlusion technique to assist total aortic arch replacement (TAR) with frozen elephant trunk (FET) to shorten the lower body circulatory arrest (CA) time and raise the nadir temperature during cardiopulmonary bypass. Methods This retrospective study reviewed consecutive patients that underwent aortic balloon occlusion to assist TAR with FET and patients that received conventional TAR with FET procedures. Preoperative characteristics, perioperative characteristics and postoperative outcomes were compared between the two groups. Results The study included130 patients treated with aortic balloon occlusion and 230 patients treated with conventional TAR with FET. The 30-day mortality rate was similar between the aortic balloon occlusion and conventional groups (4.62% versus 7.83%, respectively). Multivariate analysis showed that aortic balloon occlusion reduced the incidence of acute kidney injury, hepatic injury and red blood cell transfusion. The application of aortic balloon occlusion reduced the mean ± SD CA time from 17.24 ± 4.36 min to 6.33 ± 5.74 min, with the target nadir nasal temperature being increased from 25°C to 28°C. Conclusion The aortic balloon occlusion technique achieved significant improvements in reducing complications, but this did not translate into lower 30-day mortality.

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Cerebral perfusion issues in type A aortic dissection

Cited by 20 publications

References 30 publications

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

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

The strategy of cardiopulmonary bypass for total aortic arch replacement and the frozen elephant trunk technique with aortic balloon occlusion

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