Surgical results of acute aortic dissection complicated with cerebral malperfusion.
BACKGROUND
In patients with acute type A aortic dissection complicated by cerebral malperfusion, the surgical treatment remains challenging. This retrospective study reports the results of surgical interventions and the clinical features of these patients.


METHODS
From 1999 to 2004, 63 patients underwent surgical treatment for acute type A aortic dissection. Sixteen patients (25.3%) showed preoperative newly developed neurologic deficits (cerebral malperfusion). In patients with cerebral malperfusion, the characteristics, neurologic symptoms, computed tomography findings, interval from onset to operation, and operative details (procedure, arterial cannulation site, method of brain protection) were reviewed.


RESULTS
The hospital mortality rate was 43.7% (7 of 16 patients) for the cerebral malperfusion group and 17.0% (8 of 47 patients) for the noncerebral malperfusion group (all patients, 23.8%). Multivariate analysis showed preoperative cerebral malperfusion as the sole risk factor for hospital mortality. Six patients, including all patients in a preoperative coma, died of severe brain damage within 1 month after surgery. Most patients were diagnosed with right hemispheric cerebral infarction by postoperative brain computed tomography. The operative details and the time interval from onset to operation were not significant predictors of death. The cumulative survival rate at 4 years was 75.5% in patients without cerebral malperfusion and 50.1% with cerebral malperfusion (p = 0.091).


CONCLUSIONS
The results of surgical treatment for acute type A dissection complicated with cerebral malperfusion demonstrated high hospital mortality, but the long-term survival was similar to patients without cerebral malperfusion, with an acceptable neurologic outcome, excluding preoperative coma patients. Appropriate protection of ischemic brain tissue should be implemented to improve the surgical results in these patients.
Tanaka
Hiroshi
H
Department of Cardiovascular, Thoracic, and Pediatric Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. hirot@ams.odn.ne.jp
Okada
Kenji
K
Yamashita
Teruo
T
Morimoto
Yoshihisa
Y
Kawanishi
Yujiro
Y
Okita
Yutaka
Y
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D002545:Brain Ischemia / Q000209:etiology*; D013504:Cardiovascular Surgical Procedures; D002544:Cerebral Infarction / Q000209:etiology; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome