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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
785
Preoperative neurological deficit in acute type A aortic dissection
Maximilian Kreibich1,2, Nimesh D Desai1, Joseph E Bavaria1
1Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Interactive Cardiovascular and Thoracic Surgery
|January 21, 2020
Summary
Most patients with type A aortic dissection and neurological deficits have good postoperative outcomes. However, advanced age and a history of stroke predict poor outcomes, suggesting prompt surgical intervention is beneficial.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Type A aortic dissection can lead to preoperative neurological deficits.
- Evaluating outcomes in these patients is crucial for treatment decisions.
Purpose of the Study:
- To assess postoperative outcomes in patients with type A aortic dissection and preoperative neurological deficits, excluding those in shock.
Main Methods:
- Retrospective analysis of 150 patients with type A aortic dissection and neurological deficits from 2002-2017.
- Outcomes classified using modified Rankin Scale (mRS 0-3 for no to moderate disability, mRS 4-6 for poor outcome).
- Clinical and radiographic data analyzed for predictive factors.
Main Results:
- 62% of patients achieved no to moderate disability (mRS 0-3).
- In-hospital mortality was 18%.
- Poor outcomes were associated with older age, hypertension, history of stroke, and carotid artery occlusion. Longer cardiopulmonary bypass and cross-clamp times were observed in patients with poor outcomes. Age and history of stroke predicted poor outcomes.
Conclusions:
- The majority of patients with preoperative neurological deficits experience favorable postoperative recovery.
- Preoperative neurological deficits and coma may warrant immediate surgical intervention.
- Hemodynamic instability is a common complication.
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