Pre-operative Cerebral Malperfusion in Patients with Acute Type A Aortic Dissection Involving the Supra-aortic Branches: Treatment and Early Outcome Maximilian.

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Presentation transcript:

Pre-operative Cerebral Malperfusion in Patients with Acute Type A Aortic Dissection Involving the Supra-aortic Branches: Treatment and Early Outcome Maximilian Luehr, Christian D. Etz, Lukas Lehmkuhl, Pascal Dohmen, Martin Misfeld, Michael A. Borger and Friedrich W. Mohr

Objective Acute Type A dissection may involve the supra-aortic branches causing cerebral malperfusion Extra-anatomic bypass to the left (LCCA) and/or right (RCCA) common carotid artery was performed to allow for complete revascularization Distal occlusion may occur due to thrombus formation or false lumen perfusion

Single Center Experience Between 09/2009 and 04/2011, 81 pts with acute type A aortic dissection underwent hemiarch (n=54) or complete aortic arch (n=27) replacement 10 pts presented with distal occlusion of the left (LCCA) and/or right common carotid artery (RCCA) Extra-anatomic bypass to the LCCA (n=7) and/or the RCCA (n=4) was performed in all 10 pts

Pre-op CT scan - Distal occlusion of the RCCA or LCCA

Methods - Operative technique After CPB initiation the distal non-dissected portion of the RCCA or LCCA was located and prepared A prosthetic graft was anastomosed end-to-end (-side) and unilateral antegrade selective cerebral perfusion was started Aortic Arch repair was continued using the island (n=1) or trifurcated graft (n=3) technique Hemiarch replacement was performed in 6 pts

Hemiarch replacement and LCCA bypass

Operative technique - Postop CT scan

Operative data

Results No in-hospital mortality occurred in the 10 pts 1 pt developed stroke after CPR in another hospital due to significant pericardial effusion Transient hemiparesis occurred in 2 pts with pre-operative temporal (n=1) and frontal (n=1) lobe ischemia All 10 pts were alive during follow-up of 27+/-14 months

Conclusions Extra-anatomic bypass allows for complete re-vascularisation in cases of acute cerebral malperfusion due to type A aortic dissection with involvement of the supra-aortic branches and can be performed with very satisfactory results