title: Neurological outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma.
abstract: BACKGROUND
  Management of acute type A aortic dissection (AADA) complicated by coma remains controversial. We analyzed our experience in managing AADA complicated by coma to determine the relationship of duration of preoperative coma to postoperative neurological recovery.
  
  
  RESULTS
  Between September 2003 and October 2010, 181 patients with AADA were treated, including 27 presenting with coma (Glasgow Coma Scale <11) on arrival. Twenty-one patients were repaired immediately (immediate group); time from onset of symptoms to operating room was <5 hours. For brain protection, deep hypothermia with antegrade cerebral perfusion was used, and postoperative therapeutic hypothermia with magnesium treatment was performed. Six patients initially were managed medically, and 3 of them were followed by eventual repair because time from onset was >5 hours (delayed group). The preoperative National Institutes of Health Stroke Scale score was 31.4 ± 6.6 in the immediate group and 28.3 ± 9.5 in the delayed group. Hospital mortality was 14% in the immediate group and 67% in the delayed group. Full recovery of consciousness was achieved in 86% of patients in the immediate group and in 17% in the delayed group. In immediate group, the postoperative National Institutes of Health Stroke Scale score significantly improved to 6.4 ± 8.4, cumulative survival rate was 71.8% in 3 years, and independence in daily activities was achieved in 52% (11/21).
  
  
  CONCLUSIONS
  Aortic repair, if performed immediately from the onset of symptoms, showed satisfactory recovery of consciousness and neurological function in patients with AADA complicated by coma. In this patient population, immediate aortic repair is warranted.
authors.affiliation: Division of Cardiovascular Surgery and Emergency Medicine, Japanese Red Cross Kobe Hospital and Hyogo Emergency Medical Center, and Division of Cardiovascular Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan. t-tsukube@kobe.jrc.or.jp
authors.forename: Takuro
authors.initials: T
authors.lastname: Tsukube
authors.forename: Taro
authors.initials: T
authors.lastname: Hayashi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kawahira
authors.forename: Tomonori
authors.initials: T
authors.lastname: Haraguchi
authors.forename: Ritsu
authors.initials: R
authors.lastname: Matsukawa
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kozawa
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Ogawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D003071:Cognition / Q000502:physiology*; D003128:Coma / Q000209:etiology*; D003243:Consciousness / Q000502:physiology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*