Objective: The study objective was to evaluate the surgical results in patients with acute type A aortic dissection and cerebral malperfusion. Methods: From 2000 to 2019, 234 patients with type A aortic dissection and cerebral malperfusion were stratified into 3 groups: 50 (21%) with syncope (group 1), 152 (65%) with persistent loss of focal neurological function (group 2), and 32 (14%) with coma (group 3). Results were evaluated and compared by univariable and multivariable analyses. Results: Median age was higher in group 1, and incidence of cardiogenic shock was higher in group 3. The femoral artery was the most common cannulation site, whereas the axillary artery was used in 18% of group 1, 30% of group 2, and 25% of group 3 patients (P = .337). Antegrade cerebral perfusion was performed in more than 80% of patients, and ascending aorta/arch replacement was performed in 40% of group 1, 27% of group 2, and 31% of group 3 (P = .21). In-hospital mortality was 18% in group 1, 27% in group 2, and 56% in group 3 (P = .001). Survival at 5 years is 57.0% in group 1, 57.7% in group 2, and 38.7% in group 3 (P = .0005). On multivariable analysis, age, cardiopulmonary bypass time, and group 3 versus group 2 were independent risk factors for mortality, whereas axillary cannulation was a protective factor. Conclusions: Patients with aortic dissection and cerebral malperfusion without preoperative coma showed acceptable mortality, and those with coma had a high in-hospital mortality regardless of the type of brain protection. Overall axillary artery cannulation appeared to be a protective factor.

Vendramin I., Isola M., Piani D., Onorati F., Salizzoni S., D'Onofrio A., et al. (2022). Surgical management and outcomes in patients with acute type A aortic dissection and cerebral malperfusion. JTCVS OPEN, 10, 22-33 [10.1016/j.xjon.2022.03.001].

Surgical management and outcomes in patients with acute type A aortic dissection and cerebral malperfusion

Di Marco L.;Pacini D.;
2022

Abstract

Objective: The study objective was to evaluate the surgical results in patients with acute type A aortic dissection and cerebral malperfusion. Methods: From 2000 to 2019, 234 patients with type A aortic dissection and cerebral malperfusion were stratified into 3 groups: 50 (21%) with syncope (group 1), 152 (65%) with persistent loss of focal neurological function (group 2), and 32 (14%) with coma (group 3). Results were evaluated and compared by univariable and multivariable analyses. Results: Median age was higher in group 1, and incidence of cardiogenic shock was higher in group 3. The femoral artery was the most common cannulation site, whereas the axillary artery was used in 18% of group 1, 30% of group 2, and 25% of group 3 patients (P = .337). Antegrade cerebral perfusion was performed in more than 80% of patients, and ascending aorta/arch replacement was performed in 40% of group 1, 27% of group 2, and 31% of group 3 (P = .21). In-hospital mortality was 18% in group 1, 27% in group 2, and 56% in group 3 (P = .001). Survival at 5 years is 57.0% in group 1, 57.7% in group 2, and 38.7% in group 3 (P = .0005). On multivariable analysis, age, cardiopulmonary bypass time, and group 3 versus group 2 were independent risk factors for mortality, whereas axillary cannulation was a protective factor. Conclusions: Patients with aortic dissection and cerebral malperfusion without preoperative coma showed acceptable mortality, and those with coma had a high in-hospital mortality regardless of the type of brain protection. Overall axillary artery cannulation appeared to be a protective factor.
2022
Vendramin I., Isola M., Piani D., Onorati F., Salizzoni S., D'Onofrio A., et al. (2022). Surgical management and outcomes in patients with acute type A aortic dissection and cerebral malperfusion. JTCVS OPEN, 10, 22-33 [10.1016/j.xjon.2022.03.001].
Vendramin I.; Isola M.; Piani D.; Onorati F.; Salizzoni S.; D'Onofrio A.; Di Marco L.; Gatti G.; De Martino M.; Faggian G.; Rinaldi M.; Gerosa G.; Pac...espandi
File in questo prodotto:
File Dimensione Formato  
PIIS266627362200122X.pdf

accesso aperto

Tipo: Versione (PDF) editoriale
Licenza: Licenza per Accesso Aperto. Creative Commons Attribuzione - Non commerciale - Non opere derivate (CCBYNCND)
Dimensione 1.08 MB
Formato Adobe PDF
1.08 MB Adobe PDF Visualizza/Apri
10.1016-j.xjon.2022.03.001Figure4.pptx

accesso aperto

Tipo: File Supplementare
Licenza: Licenza per Accesso Aperto. Altra tipologia di licenza compatibile con Open Access
Dimensione 186.67 kB
Formato Microsoft Powerpoint XML
186.67 kB Microsoft Powerpoint XML Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/902751
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 8
  • ???jsp.display-item.citation.isi??? ND
social impact