Intentional Surgical Delay in Acute Type A Aortic Dissection With Cerebral Malperfusion

Area of Science:

• Cardiovascular Surgery
• Neurology
• Aortic Diseases

Background:

• Acute type A aortic dissection with cerebral malperfusion presents significant management challenges.
• Optimal treatment strategies lack consensus, with immediate open surgical repair being the predominant approach.
• Intentional surgical delay is rarely reported in contemporary practice.

Purpose of the Study:

• To evaluate the feasibility and outcomes of intentional surgical delay in patients with acute type A aortic dissection complicated by cerebral malperfusion.
• To present case studies demonstrating a deferred surgical approach.

Main Methods:

• Two cases of acute type A aortic dissection with cerebral malperfusion were managed with intentional surgical delay.
• Open proximal aortic repair was deferred for five months, performed after neurological recovery or stabilization.

Main Results:

• Patient 1 was discharged on postoperative day 11 with preserved neurological function.
• Patient 2 was discharged on postoperative day 21 without new neurological deficits.
• Both patients experienced favorable neurological outcomes following delayed repair.

Conclusions:

• Intentional surgical delay may be a feasible and beneficial strategy for carefully selected patients.
• This approach warrants consideration in acute type A aortic dissection cases with cerebral malperfusion.
• Deferred surgical intervention can lead to positive neurological recovery.