Acute type A aortic dissection complicated by stroke: Can immediate repair be performed safely?
Acute type A aortic dissection complicated by stroke: Can immediate repair be performed safely?
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DOI：
10.1016/j.jtcvs.2006.07.026
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发表时间：
2006-12-01
影响因子：
6
通讯作者：
Safi, Hazim J.
中科院分区：
文献类型：
--
作者：
Estrera, Anthony L.;Garami, Zsolt;Safi, Hazim J.
目的：急性A型主动脉夹层合并卒中的急诊手术治疗仍存在争议。在这种情况下，立即修复的紧迫性受到脑再灌注可能使神经功能结局恶化的担忧的影响。本研究的目的是报告和分析我们的结果与急性A型主动脉夹层并发stroke.Methods：1999年9月至2005年3月，151例连续急性A型主动脉夹层。该组中，16例（10.6%）患者术前发生卒中。平均年龄为56岁（范围43-73岁），其中6例（38%）为女性。右半球、左半球和双侧卒中的发生率分别为81%、13%和6%。计算机断层扫描或经食管超声心动图诊断为主动脉夹层;临床检查、计算机断层扫描或经颅多普勒超声诊断为卒中。在体外循环、深低温停循环和逆行脑灌注下进行主动脉修复。结果：16例患者中有1例神经系统完全破坏（昏迷），未行手术治疗，死亡率为18.8%（3/16）。未接受手术的2例患者（1例患者神经系统受损，1例患者在等待手术时主动脉破裂）的死亡率为100%（2/2）。手术死亡率为7%（1/14）。在接受手术的患者中，2例（14%）患者的神经功能状态完全恢复，6例（43%）患者改善，6例（43%）患者保持不变，无患者恶化。从卒中发作到手术的中位时间为9小时（范围1-240小时）。在10小时内接受手术修复的患者中，80%的患者神经功能状态得到改善，而超过10小时的患者无一改善（P
Objective: Emergency surgical intervention for acute type A aortic dissection complicated by stroke remains controversial. The urgency of immediate repair in this setting is tempered by the concern that cerebral reperfusion may worsen neurologic outcome. The purpose of this study was to report and analyze our results with acute type A aortic dissection complicated by stroke.Methods: Between September 1999 and March 2005, 151 consecutive patients presented with acute type A aortic dissection. Of this group, 16 (10.6%) patients had sustained a preoperative stroke. Mean age was 56 years (range 43-73 years), with 6 (38%) women. Right hemispheric, left hemispheric, and bilateral strokes occurred in 81%, 13%, and 6%, respectively. Computed tomographic scan or transesophageal echocardiography diagnosed aortic dissection; clinical examination, computed tomographic scan, or transcranial Doppler ultrasound diagnosed stroke. Aortic repair was performed with cardiopulmonary bypass, profound hypothermic circulatory arrest, and retrograde cerebral perfusion. One patient with complete neurologic devastation (coma) was not operated on.Results: Overall hospital mortality was 18.8% (3/16). Mortality in 2 patients who did not undergo surgery (1 patient who was neurologically devastated, and 1 patient whose aorta ruptured while awaiting surgery) was 100% (2/2). Operative mortality was 7% (1/14). Among patients undergoing surgery, neurologic status completely recovered in 2 (14%) patients, improved in 6 (43%) patients, remained the same in 6 (43%) patients, and worsened in none. Median time from onset of stroke to surgery was 9 hours (range 1-240 hours). Eighty percent of patients who underwent surgical repair within 10 hours had improvement in neurologic status, where as none operated on beyond 10 hours improved (P