Prompt surgery is effective for acute type A aortic dissection with cerebral ischemia

Abstract

Background: Acute type A aortic dissection (aTAAD) with preoperative cerebral ischemia (CI) is common and lethal, but the timing and treatment method remain uncertain. We retrospectively reviewed our aTAAD patients with CI and analyzed the outcomes and related risk factors. Methods: From January 2011 to December 2019, 1,173 patients diagnosed with aTAAD from Nanjing Drum Tower Hospital were enrolled. Among them, 131 patients had CI preoperatively (CI group), and 1,042 patients were in the non-CI group. One hundred eight in the CI group and 984 in the non-CI group received central repair surgery. Fifteen patients had postoperative cerebral complications (CC) and 93 had non-CCs. ROC curves were used to identify the safe duration of preoperative CI. Results: The CI group was older (56.3 vs. 53.2 years, P=0.013) and had lower rates of pain, chest pain and back pain (77.9% vs. 94.4%, 75.4% vs. 87.5% and 30.8% vs. 42.3%, respectively) than the non-CI group.The CI group had a higher rate of preoperative hypotension and tamponade (13.7% vs. 6.0%, 26.9% vs.10.4%, respectively; P=0.000). More patients in the CI group did not receive central repair surgery, and the CI had higher mortality (28.2% vs. 15.9%). CI without central repair surgery was a strong risk factor for mortality. CI patients with CC after central repair had a higher mortality, and preoperative coma was the strongest risk factor for postoperative CC.A duration between CI symptoms and central repair surgery of less than 12.75 hours is recommended. Conclusions: Prompt surgery is effective for aTAAD with CI, and preoperative coma and a safe duration longer than 12.75 hours would predict worse outcomes.

Construction of a lactate-related prognostic signature for predicting prognosis after surgical repair for acute type a aortic dissection

“…This discrepancy could be explained by the fact that prompt surgery was often performed for these patients in our center. Under such a policy, the prognosis of these patients following emergent surgery can be similar to those who did not present with malperfusion syndromes upon admission ( Xue et al, 2021 ). With recent advances of surgical techniques and equipment, the overall perioperative mortality and long‐term survival rate of ATAAD patients with organ malperfusion has been greatly improved.…”

Extra-anatomic revascularization and a new cannulation strategy for preoperative cerebral malperfusion due to severe stenosis or occlusion of supra-aortic branch vessels in acute type A aortic dissection

“…Tsukube et al [ 32 ] suggested that surgery immediately after coma symptoms (within 5 h) is the preferred method of treating such patients. Xue et al [ 33 ] reported that immediate surgery is recommended for patients with transient coma. Overall, coma duration greater than 12.75 h is associated with a poor prognosis.…”

Determinant of outcome in late presenting type A aortic dissection

“…This has been supported by a recent report on patients presenting with cerebral ischemia, where surgical repair of aortic dissection within 12.5 h, was associated with favourable outcome. 19 Coronary malperfusion leading to ischemia requires an aortic root replacement in most instances or concomitant coronary artery bypass grafting and carries a significantly higher mortality. 20…”