Cerebral Autocross Perfusion Concept in Acute Type A Aortic Dissection Including Supra-Aortic Vessels

Background: The aim of the study was to evaluate pre- and postoperative clinical and neurological outcome of the cerebral autocross perfusion concept (CAPC)—a new operative approach—using the modified Rankin-scale in patients with acute aortic dissection type A (AADTA) and preoperative cerebral malperfusion due to occlusion/hemodynamic compromise of the right and/or left common carotid artery (RCCA/LCCA).

Method: Between 2015 and 2021, a total of 25 (9%) of 273 AADTA patients [median age: 57.1 years; interquartile range (IQR): 36.3–62.9] suffered from cerebral malperfusion due to unilateral occlusion/hemodynamic compromise of the RCCA (n = 4)/LCCA (n = 16) or bilateral (n = 5). In this cohort, immediate extra-anatomic revascularization by aorto-carotid bypassing was performed before AADTA repair using the FET procedure in all patients.

Results: Thirty-day and last follow-up mortality rates were 12% (n = 3/25 patients) and 5% (n = 1/22 patients), respectively. Median follow-up was 21.5 months, and 100% complete. Median hospital/ICU stay were 18.6 (IQR: 10.3–24.8) and 11.4 (IQR: 3.3–15.5) days, respectively. Survival at last FU was 84%. Rethoracotomy for bleeding and cardiac tamponade was performed in 7 (28%) patients. Postoperative complications consisted of temporary respiratory failure (n = 13; 52%), renal insufficiency with temporary dialysis (n = 5; 20%), and visceral malperfusion requiring stent-grafting (n = 3; 12%). 21 patients (84%) had no to moderate disability (mRS 0–3) and 4 (16%) had a poor clinical outcome (mRS 4–6). Patients with poor clinical outcomes had significantly higher incidence of bilateral CCA-occlusion: p = 0.01. Overall survival after 12 months of the 25 patients (Group A = extra-anatomic complex transposition) versus 106 AADTA patients without proximal RCCA/LCCA occlusion (Group B = without extra-anatomic complex transposition) was 88% (96%:75–100%) in Group A versus 68% (96%: 59–78%) in Group B (p = 0.04).

Conclusion: CAPC is a new concept and has not yet been described. CAPC enables early selective cerebral perfusion before AADTA repair. Reported data may be beneficial in patients with preoperative cerebral neurological sequelae.

Publication History

Article published online:
03 February 2022