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Coma might not preclude emergency operation in acute aortic dissection.

Marco Pocar1, Davide Passolunghi, Andrea Moneta

  • 1Università degli Studi di Milano, Policlinico MultiMedica, Milan, Italy. mpocar@milanocuore.org

The Annals of Thoracic Surgery
|March 28, 2006
PubMed
Summary

Emergency aortic repair may be viable for select acute type A aortic dissection patients with coma. This study found no operative deaths and good recovery in most patients, suggesting coma is not an absolute contraindication.

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Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Acute Aortic Dissection

Background:

  • Acute aortic dissection (AAD) frequently presents with neurological deficits, including syncope and focal deficits.
  • Coma and stroke due to arch vessel involvement are typically contraindications for emergency aortic repair.
  • This study explores emergency surgery in AAD patients with coma.

Purpose of the Study:

  • To evaluate the safety and efficacy of emergency surgical repair in hemodynamically stable, comatose patients with acute type A aortic dissection.
  • To determine if coma is an absolute contraindication for aortic repair in this patient population.

Main Methods:

  • Five hemodynamically stable, comatose patients (Glasgow Coma Score median 5.5) with preserved pupillary reactivity and coma <12 hours underwent emergency repair.

Related Experiment Videos

  • Ascending aorta replacement was performed using profound hypothermic circulatory arrest.

    • Main Results:

    • No operative deaths occurred.
    • Three patients developed postoperative ischemic strokes, all right-sided.
    • Four patients had full neurological recovery; one experienced partial recovery with hemiparesis and cognitive impairment.

    Conclusions:

    • Coma may not be an absolute contraindication for emergency surgery in hemodynamically stable AAD patients.
    • Further research with larger cohorts is needed to confirm these findings.