Original article: cardiovascularEmergency operation for acute type A aortic dissection: neurologic complications and early mortality
Section snippets
Patients
Between April 1992 and May 1998, 85 consecutive patients were operated on for acute type A aortic dissection at the Institute of Cardiac Surgery, University of Rome “La Sapienza.”
Preoperative clinical symptoms, which included precordial pain, back pain, or abdominal pain, were present in all patients. Mean time between symptoms onset and operation was 22.9 ± 15.6 hours (range, 6 to 43 hours). Complications at hospital admission and incremental risk factors for death and neurologic deficit are
Results
Mean age of the study population was 60.1 ± 11.6 years (range, 20 to 82 years). Sixty-four patients (75.3%) were men and 21 (24.7%) were women. Operative data and postoperative complications are listed in Table 1. Mean bypass time was 202.2 ± 64.2 minutes (range, 105 to 410 minutes). Mean circulatory arrest time was 59.9 ± 36.9 minutes (range, 15 to 174 minutes).
One patient that had undergone a previous Bentall’s operation for acute type A aortic dissection presented in hemodynamic shock for
Comment
This study identified, in a large series of patients, factors for hospital mortality and neurologic complications after emergent operation for acute type A aortic dissection. The main goals of surgical treatment of patients with an acute type A are to prevent aortic rupture, reverse organ ischemia, and correct aortic valve pathology, but the operation must be performed before these complications occur or their effect become irreversible.
Despite the recent advances in circulatory and
Acknowledgements
We thank Professor Sir Magdi Yacoub for his kind review of our manuscript.
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Type-A Aortic Dissection and Cerebral Perfusion: The Society of Thoracic Surgeons Database Analysis
2020, Annals of Thoracic SurgeryCitation Excerpt :This study of the STS Adult Cardiac Surgical Database represents contemporary practice of cerebral perfusion strategies in acute type A aortic dissection repair. Multiple retrospective studies, including large database reviews and meta-analyses of the literature, concluded that adjunctive cerebral perfusion is superior to DHCA alone for cerebral protection in aortic arch surgery, but they predominantly focused on elective aneurysm repair rather than acute type A aortic dissection.2-6,17,18 Our analysis confirms similar findings in patients undergoing elective aortic surgery.19
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2017, Journal of Cardiothoracic and Vascular AnesthesiaLong-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair
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