Emergency operation for acute type A aortic dissection: neurologic complications and early mortality

Sinatra, Riccardo; Melina, Giovanni; Pulitani, Ivana; Fiorani, Brenno; Ruvolo, Giovanni; Marino, Benedetto

doi:10.1016/s0003-4975(00)01824-5

Cited by 65 publications

(45 citation statements)

References 13 publications

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“…Surgical outcome is similar to that of other studies. 13,14 Observed morbidities are also in the already reported range. 13,14 In our collective, the use of ACP did not reduce the incidence of neurological events.…”

Section: Discussionsupporting

confidence: 69%

“…13,14 Observed morbidities are also in the already reported range. 13,14 In our collective, the use of ACP did not reduce the incidence of neurological events. 8,9 The results of the present study generally confirm our previous findings showing superior QoL in patients with thoracic aortic aneurysms as compared with patients with acute type A dissections.…”

Section: Discussionsupporting

confidence: 69%

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Improvement of Quality of Life After Surgery on the Thoracic Aorta

et al. 2004

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Section: Discussionsupporting

confidence: 69%

Section: Discussionsupporting

confidence: 69%

Improvement of Quality of Life After Surgery on the Thoracic Aorta

et al. 2004

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“…Blanco et al [27] reported an overall in-hospital mortality rate of 66.6% and a mortality rate of 77.7% in patients with neurological symptoms. However, in both studies overall in-hospital mortality rates were clearly higher than reported in most studies (9–36%) [5, 31,51,52,53, 55, 56,58,59,60]. …”

Section: Impact Of Prognosis Due To Initial Neurological Symptomscontrasting

confidence: 59%

Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

2008

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Typically, aortic dissection has to be considered in patients with acute thoracic or abdominal pain and accompanying cardiovascular symptoms. Due to these clinical symptoms, neurologists have not been involved in the routine emergency management of aortic dissection. However, transient or permanent neurological symptoms at onset of aortic dissection are not only frequent (17–40% of the patients), but often dramatic and may mask the underlying condition. Especially in pain-free dissection (which occurs in 5–15%) with predominant neurological symptoms diagnosis of aortic dissection can be difficult and delayed. Affecting the outflow of supra-aortal, spinal as well as extremity arteries leads to a variety of neurological symptoms including disturbances of central or peripheral nervous system. Thrombolysis as an emergency stroke therapy without considering aortic dissection may be life-threatening for these patients. Routine chest X-ray and being alert to physical examination findings such as hypotension, asymmetrical pulses or cardiac murmur may reduce risk of delayed diagnosis or misdiagnosis. Neurological symptoms at onset or in the postoperative course of aortic dissection are not necessarily associated with increased mortality.

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“…In the last decade, RCP has become less popular in spite of good reported results. 13,14 Because of our very low patient numbers, we cannot compare RCP to other forms of cerebral protection. ACP preserves the natural flow direction, allows for higher pressure, and probably provides metabolically adequate perfusion.…”

Section: Cerebral Perfusionmentioning

confidence: 99%

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

et al. 2011

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on behalf of the GERAADA Investigators Background-Cerebral protection during surgery for acute aortic dissection type A relies on hypothermic circulatory arrest, either alone or in conjunction with cerebral perfusion. Methods and Results-The perioperative and intraoperative conditions of 1558 patients submitted from 44 cardiac surgery centers in German-speaking countries were analyzed. Among patients with acute aortic dissection type A, 355 (22.8%) underwent surgery with hypothermic circulatory arrest alone. In 1115 patients (71.6%), cerebral perfusion was used: Unilateral antegrade cerebral perfusion (ACP) in 628 (40.3%), bilateral ACP in 453 (29.1%), and retrograde perfusion in 34 patients (2.2%). For 88 patients with acute aortic dissection type A (5.6%), no circulatory arrest and arch intervention were reported (cardiopulmonary bypass-only group). End points of the study were 30-day mortality (15.9% overall) and mortality-corrected permanent neurological dysfunction (10.5% overall). The respective values for the cardiopulmonary bypass-only group were 11.4% and 9.1%. Hypothermic circulatory arrest alone resulted in a 30-day mortality rate of 19.4% and a mortality-corrected permanent neurological dysfunction rate of 11.5%, whereas the rates were 13.9% and 10.0%, respectively, for unilateral ACP and 15.9% and 11.0%, respectively, for bilateral ACP. In contrast with the ACP groups, there was a profound increase in mortality when systemic circulatory arrest times exceeded 30 minutes in the hypothermic circulatory arrest group (PϽ0.001). Mortality-corrected permanent neurological dysfunction correlated significantly with perfusion pressure in the ACP groups. Conclusions-This

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Emergency operation for acute type A aortic dissection: neurologic complications and early mortality

Cited by 65 publications

References 13 publications

Improvement of Quality of Life After Surgery on the Thoracic Aorta

Improvement of Quality of Life After Surgery on the Thoracic Aorta

Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

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