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Review
. 2018 Apr 24:4:77.
doi: 10.21037/jovs.2018.03.20. eCollection 2018.

Cerebral perfusion issues in type A aortic dissection

Davide Pacini  1 , Giacomo Murana  1 , Luca Di Marco  1 , Marianna Berardi  1 , Carlo Mariani  1 , Giuditta Coppola  1 , Mariafrancesca Fiorentino  1 , Alessandro Leone  1 , Roberto Di Bartolomeo  1
Affiliations
Review

Cerebral perfusion issues in type A aortic dissection

Davide Pacini et al. J Vis Surg. .

Abstract

Stroke events are very common in acute type A aortic dissection. Cerebral malperfusion could manifest at presentation due to prolonged arch vessels hypoperfusion or develop after surgery for inadequate cerebral protection during arch repair. To reduce this detrimental complication there are several adjuncts that can be adopted for cerebral protection such as direct antegrade or retrograde cerebral perfusion (RCP) and use period of deep to moderate hypothermic circulatory arrest time; however, they are often insufficient as preoperative malperfusion already caused irreversible ischemic damages. The aim of the current review article is to analyze the principal series reporting on neurological injuries during type A aortic dissection to focus on the outcomes according to the type of surgical management and identify possible predictors to better manage this complication.

Keywords: Type A aortic dissection; antegrade selective cerebral perfusion (ASCP); brain protection; cerebral perfusion; hypothermic circulatory arrest.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Angio-CT reconstruction showing a type A aortic dissection with a severe involvement of the epiaortic vessels. CT, computed tomography.
Figure 2
Figure 2
Angio-CT of patients with (A) type A aortic dissection presenting with signs of cerebral (B) and visceral (C) malperfusion. CT, computed tomography.
See this image and copyright information in PMC

References

    1. Rylski B, Urbanski PP, Siepe M, et al. Operative techniques in patients with type A dissection complicated by cerebral malperfusion. Eur J Cardiothorac Surg 2014;46:156-66. 10.1093/ejcts/ezu251 - DOI - PubMed
    1. Cefarelli M, Murana G, Surace GG, et al. Elective Aortic Arch Repair: Factors Influencing Neurologic Outcome in 791 Patients. Ann Thorac Surg 2017;104:2016-23. 10.1016/j.athoracsur.2017.05.009 - DOI - PubMed
    1. Pacini D, Di Marco L, Leone A, et al. Cerebral functions and metabolism after antegrade selective cerebral perfusion in aortic arch surgery. Eur J Cardiothorac Surg 2010;37:1322-31. 10.1016/j.ejcts.2009.12.029 - DOI - PubMed
    1. Isselbacher EM, Bonaca MP, Di Eusanio M, et al. Recurrent Aortic Dissection: Observations From the International Registry of Aortic Dissection. Circulation 2016;134:1013-24. 10.1161/CIRCULATIONAHA.115.019359 - DOI - PubMed
    1. Dumfarth J, Kolfer M, Stastny L, et al. Stroke after emergent surgery for acute type A aortic dissection: predictors, outcome and neurological recovery. Eur J Cardiothorac Surg 2018. [Epub ahead of print]. 10.1093/ejcts/ezx465 - DOI - PubMed

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