Impact of Selective Cerebral Perfusion Management on the Neurological Outcome in Patients with Acute Type A Aortic Dissection

Objective: Stroke represents a serious complication following aortic arch repair for acute type A aortic dissection (ATAAD). Aim of the study was to determine the effectiveness of different selective cerebral perfusion (SCP) modalities for brain protection during emergency aortic surgery for ATAAD.

Methods: The clinical records of 75 consecutive patients with ATAAD who were referred between 2013 and 2015 to our institution for emergency aortic repair were reviewed. 18 patients presented stroke at admission and were excluded. In 6 cases only the ascending aorta was affected by dissection and no hypothermic circulatory arrest (HCA) with SCP was needed. Finally 51 patients (65% males, 60 ± 14 years, EuroScore 15 ± 11, BMI 26 ± 4) with aortic arch repair using HCA and SCP were found eligible for this study. HCA was performed at 26–28°C with or without using either unilateral SCP, through direct catheterization of the right axillary artery and consecutive clamping of the brachiocephalic trunk, or bilateral SCP with additional left carotid artery perfusion. The impact of SCP-modality (unilateral vs. bilateral), SCP- and lower body ischemia (LBI) time and SCP-flow (≥10 vs. < 10 mL/kg/min) on the occurrence of postoperative stroke was analyzed using T- and Mann-Whitney-U-Test.

Results: The over-all mortality-, stroke-rates were 14,9%, and 14% respectively.) Bilateral SCP in 46 patients (90,2%). Mean LBI- and SCP-time was 64,2 and 56,3 minutes respectively. 32 patients (64%) underwent surgery with a flow ≥10 mL/kg/min (group A) and 18 patients (36%) underwent surgery with < 10 mL/kg/min (group B). LBI- and SCP-time as well as unilateral or bilateral use of SCP had no influence on the occurrence of postoperative stroke or TND. Differences were seen only regarding the used SCP-flow: the postoperative stroke rate was significantly lower (p = 0,049) in group A (6,3%) when compared with group B (27,8%).

Conclusion: According to our findings, we suggest to perform emergency aortic surgery with antegrade selective cerebral perfusion flow/KG ≥10 mL to avoid neurological dysfunction or/and stroke in patients with acute aortic dissection.

No conflict of interest has been declared by the author(s).