Purpose: Type A acute aortic dissection (TAAAD) complicated
with cerebral malperfusion (CM) is a life-threatening condition
associated with high mortality, poor outcomes, and the optimal surgical
management remains controversial. The aim of this review was to report
the current results of surgical interventions of these patients.
Methods: A systematic review was performed using PubMed and
MEDLINE search for cases underwent surgical repair for TAAAD with CM.
Demographics, neurological symptom, the time from onset of symptoms to
operation, operation data, mortality, neurological outcome, and
follow-up were reviewed. Results: A total of 363 patients with
mean age of 65.7±13 years underwent surgical repair for TAAAD with CM
were identified in 12 retrospective studies. In-hospital mortality was
20.1%. Mean duration of follow-up was 40.1 ± 37.6 months. The involved
supra-aortic branch vessels were RCCA (n=99), LCCA (n=25) , B-CCA
(n=52), CCA (n=131), IA (n=19), and LSA (n=8). Time from onset of
neurological symptoms to surgery was 13.3 hours. Antegrade and/or
retrograde cerebral perfusion was applied. Postoperatively, improved,
unchanged and worsened neurological status was occurred in 54.3%,
27.1%, and 8.5%, respectively in 199 patients. Conclusion:
The outcomes of surgical treatment of TAAAD complicated with CM indicate
acceptable early mortality and morbidity. It is reasonable to perform
lifesaving surgery on these patients. Early central surgical repair and
reperfusion of brain may improve the outcomes.
Surgical Treatment of Acute Aortic Dissection (Stanford type A) Associated with Myocardial Ischemia.
