Aorto-carotid bypass for type A acute aortic dissection complicated with carotid artery occlusion: no touch until...

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Type A acute aortic dissection (AAAD) with carotid artery occlusion presents a complex surgical challenge.
• Cerebral malperfusion due to carotid occlusion in AAAD is associated with high morbidity and mortality.
• Optimal surgical management strategies for this specific complication remain debated.

Purpose of the Study:

• To evaluate the efficacy and safety of surgical management for AAAD complicated by carotid artery occlusion.
• To assess the impact of aorto-carotid bypass during hemiarch or total arch replacement on neurological outcomes.
• To determine the short-term and mid-term survival rates in these high-risk patients.

Main Methods:

• Retrospective analysis of 127 patients with AAAD operated between December 2012 and June 2017.
• Nine patients (7.08%) presented with cerebral malperfusion due to innominate or right carotid artery occlusion.
• Surgical intervention involved hemiarch or total arch replacement with aorto-carotid bypass under hypothermic circulatory arrest.

Main Results:

• Hospital mortality was 0% in the studied group.
• Significant improvement in preoperative neurological deficits (hemiplegia, hemiparesis) was observed.
• All patients achieved a Japan Coma Scale score of 0 at discharge, with 100% overall survival at 24 months.

Conclusions:

• Aorto-carotid artery bypass is the recommended treatment for type A acute aortic dissection with carotid artery occlusion.
• The 'no touch until circulatory arrest' strategy may contribute to favorable neurological recovery.
• This surgical approach offers excellent outcomes in high-risk patients with complex aortic dissections.