scholarly journals Aorto-carotid bypass for type A acute aortic dissection complicated with carotid artery occlusion: no touch until circulatory arrest

2020 ◽  
Vol 31 (2) ◽  
pp. 263-265
Author(s):  
Hideki Sasaki ◽  
Takashi Harada ◽  
Hiroshi Ishitoya ◽  
Osamu Sasaki
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Artery Bypass ◽  
Type A ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Left Hemiparesis ◽  
Coma Scale

Abstract The surgical management for type A acute aortic dissection complicated with carotid artery occlusion remains controversial. Between December 2012 and June 2017, 127 patients who presented with type A acute aortic dissection were operated on in our hospital. Of this group, nine (7.08%) patients had cerebral malperfusion due to carotid artery occlusion. The site of occlusion was innominate artery (n = 5) or right carotid artery (n = 4). Preoperative neurological symptoms were left hemiplegia (n = 1), left hemiparesis (n = 3) and seizure (n = 2). Preoperative consciousness level was Japan Coma Scale 2 (n = 6), 20 (n = 2), or 200 (n = 1). The procedure consisted of hemiarch replacement (n = 4) or total arch replacement (n = 5). Aorto-carotid bypass was performed in all patients under hypothermic circulatory arrest. The time from onset of symptoms to operating room was 7.2 ± 2.4 h. Hospital mortality was 0%. Left hemiplegia and left hemiparesis improved significantly. Japan Coma Scale was 0 in all patients at discharge. Overall survival at 24 months after operation was 100%. Aorto-carotid artery bypass for type A acute aortic dissection with carotid artery occlusion is the treatment of choice in these high-risk patients. Our strategy of ‘no touch until circulatory arrest’ may contribute to neurological improvement.

scholarly journals Preoperative percutaneous carotid artery recanalization in a patient with aortic dissection type A

2021 ◽  
Author(s):  
Hug Aubin ◽  
Egzon Memedi ◽  
Arash Mehdiani ◽  
Artur Lichtenberg ◽  
Alexander Albert
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Type A ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Acute Type ◽  
Aortic Repair ◽  
Full Neurological Recovery ◽  
Percutaneous Recanalization ◽  
Artery Obstruction

Management of patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion due to carotid artery obstruction is still a major challenge and often associated with poor prognosis despite successful surgical aortic repair, due to prolonged cerebral perfusion deficit. Here, we present the first report regarding successful percutaneous recanalization of an internal carotid artery occlusion in the setting of an ATAAD prior to open surgical aortic repair with excellent clinical outcome after three year follow-up, including almost full neurological recovery.

Extra-anatomic carotid bypass in acute aortic dissection type A with carotid artery malperfusion

2020 ◽  
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Artery Bypass ◽  
Type A ◽  
Complex Situation ◽  
Total Occlusion ◽  
Aortic Replacement ◽  
Aortic Dissection Type A ◽  
Artery Perfusion

Acute aortic dissection type A with subtotal or total occlusion of one carotid artery is a complex situation. An additional extra-anatomic carotid artery bypass can restore carotid artery perfusion after standard emergency surgery with aortic replacement.

EP17 IMPACT OF A MODIFIED INTRAOPERATIVE SETTING FOR THE MANAGEMENT OF CIRCULATORY ARREST IN TYPE A ACUTE AORTIC DISSECTION

2018 ◽  
Vol 19 ◽  
pp. e48
Author(s):  
I. Vendramin ◽  
D. Piani ◽  
A. Lechiancole ◽  
V. Ferrara ◽  
M. Meneguzzi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A

scholarly journals Prognostic Implications of Acute Renal Failure after Surgery for Type A Acute Aortic Dissection

Aorta ◽  
2015 ◽  
Vol 03 (03) ◽  
pp. 91-97 ◽  
Author(s):  
Fabrizio Sansone ◽  
Alessandro Morgante ◽  
Fabrizio Ceresa ◽  
Giovanni Salamone ◽  
Francesco Patanè
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Aortic Dissection ◽  
Odds Ratio ◽  
Acute Aortic Dissection ◽  
Negative Impact ◽  
Circulatory Arrest ◽  
Postoperative Bleeding ◽  
Type A ◽  
Renal Injuries

Background: “Type A” acute aortic dissection (AAAD) is the most challenging among the emergency operations in cardiac surgery. The aim of this study was the evaluation of the role of acute renal failure (ARF) in postoperative survival of patients operated for AAAD. Methods: From February 2010 to April 2012, 37 consecutive patients were operated at our department for AAAD. We studied our population by subdividing the patients within groups according to the presence of ARF requiring continuous veno-venous hemofiltration (CVVH) and according to hypothermic circulatory arrest (HCA) times and degrees. Results: The overall 30-day mortality was 27% (50% group A with ARF, 13% group B no ARF). Acute renal failure requiring CVVH was 37.8%. Multivariate analysis revealed a significant association with 30-day mortality (odds ratio 6.6 and p = 0.020). Preoperative oliguria [urine output less than 30 ml/h (odds ratio 4.7 p = 0.039)], CPB greater than 180 minutes (odds ratio 6.5 p = 0.023) and postoperative bleeding requiring a surgical reopening (odds ratio 12.2 and p = 0.021) were the variables significantly associated with acute kidney injury. Conclusions: The data obtained from our analysis bring out the high incidence of renal injuries after surgery for AAAD, and indicate a negative impact on renal injuries of a preoperative oliguria, longer Cardiopulmonary bypass (CBP)/HCA times, and postoperative bleeding requiring a surgical revision. Our data also suggest a better 30-day survival and better renal outcomes in case of shorter HCA and lesser degree of hypothermia. The option of lesser and shorter hypothermia may be very useful, especially for the elderly patients and octogenarians.

ARCH Replacement in Acute Aortic Dissection Type a in Normothermia

2001 ◽  
Vol 71 (3) ◽  
pp. 282-286
Author(s):  
Ovidiu Stiru ◽  
Roxana Carmen Geana ◽  
Adrian Tulin ◽  
Raluca Gabriela Ioan ◽  
Victor Pavel ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Ct Scan ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Ascending Aorta ◽  
Descending Aorta ◽  
The Right ◽  
Aortic Dissection Type A

The purpose of this case presentation is to present a simplified surgical technique when in a patient with acute aortic dissection type A (AAD), aortic arch, and ascending aorta is completely replaced without circulatory arrest. A 67-year old male was presented in our institution with severe chest and back pain at 12 h after the onset of the symptoms. Imaging studies by 3D contrast-enhanced thoracic computed tomography (CT-scan) and transesophageal echocardiography (TEE) revealed ascending aortic dissection towards the aortic arch, which was extending in the proximal descending aorta. We practiced emergency median sternotomy and established cardiopulmonary bypass (CBP) between the right atrium and the right femoral artery with successive cross-clamping of the ascending and descending aorta below the origin of the left subclavian artery (LSA). In normothermic condition without circulatory arrest and with antegrade cerebral perfusion, we replaced the ascending aorta and aortic arch with a four branched Dacron graft. Patient evolution was uneventful, and he was discharged, after fourteen days from the hospital. At a one-year follow-up, 3D CT-scan showed no residual dissection with a well-circulated lumen of the supra-aortic arteries. Using the described surgical approach, CPB was not interrupted, the brain was protected, and hypothermia was no used. This approach made these surgical procedures shorter, and known complications of hypothermia and circulatory arrest are avoided.Acute aortic dissection aortic type A, total arch replacement, normothermia

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