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Resultados neurológicos después de la reparación aórtica inmediata para la disección aórtica aguda tipo A complicada
Takuro Tsukube1, Taro Hayashi, Toshihiro Kawahira
1Division of Cardiovascular Surgery and Emergency Medicine, Japanese Red Cross Kobe Hospital and Hyogo Emergency Medical Center, and Division of Cardiovascular Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan. t-tsukube@kobe.jrc.or.jp
Circulation
|September 14, 2011
Resumen
La reparación aórtica inmediata para la disección aórtica aguda tipo A (AADA) con coma mejora significativamente la recuperación neurológica y la supervivencia. La intervención quirúrgica rápida es crucial para obtener mejores resultados en estos pacientes críticos.
Área de la Ciencia:
- Cirugía cardiovascular La cirugía cardiovascular es una cirugía cardiovascular.
- Neurología Neurología.
- Medicina de cuidados críticos Medicina de cuidados críticos.
Sus antecedentes:
- El manejo de la disección aórtica aguda tipo A (AADA) con coma es controvertido.
- Es esencial evaluar el impacto de la duración del coma preoperatorio en la recuperación neurológica en pacientes con AADA.
Objetivo del estudio:
- Analizar la relación entre la duración del coma preoperatorio y la recuperación neurológica postoperatoria en pacientes con AADA.
- Para evaluar los resultados de la reparación quirúrgica inmediata versus retrasada en pacientes con AADA que se presentan con coma.
Principales métodos:
- Análisis retrospectivo de 181 pacientes con AADA (2003-2010), centrado en 27 con coma (CSG <11).
- Comparación de la reparación inmediata (<5 horas desde el inicio) frente a la reparación tardía (>5 horas desde el inicio).
- Las estrategias de protección cerebral incluyeron hipotermia profunda, perfusión cerebral antes del grado y hipotermia postoperatoria con magnesio.
Principales resultados:
- El grupo de reparación inmediata (n=21) mostró un 14% de mortalidad hospitalaria frente al 67% en el grupo retrasado (n=6).
- La recuperación completa de la conciencia se logró en el 86% del grupo inmediato frente al 17% en el grupo retrasado.
- El grupo inmediato había mejorado las puntuaciones postoperatorias del NIHSS (6.4 ± 8.4), la supervivencia a 3 años del 71.8% y el 52% de independencia.
Conclusiones:
- La reparación aórtica inmediata en pacientes AADA con coma conduce a una recuperación satisfactoria de la conciencia y la función neurológica.
- La intervención quirúrgica inmediata está justificada para los pacientes con AADA que se presentan con coma para mejorar los resultados.
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