Effect of Retrograde Cerebral Protection Strategy on Outcome of Patients with Stanford Type A Aortic Dissection.

BACKGROUND

Neurological complications are an important concern in the repair of type A aortic dissection. Supra-aortic involvement is considered to be an important risk factor for neurological injuries. However, the optimal brain protection strategy still remains controversial. The aim of the present study was to assess the efficacy and short-term results of retrograde cerebral protection techniques in the treatment of acute type A aortic dissection.

METHODS

Between 2005 and 2013, 185 patients who underwent repair of acute type A aortic dissection were enrolled in this study, all of whom received retrograde cerebral perfusion. The patients were divided into two group: 102 patients who had at least one carotid artery involved as the carotid dissection group, and 83 patients who had no carotid artery involvement as the non-carotid dissection group.

RESULTS

The mean age of the patients was 57.8 years and 69% were male. The 30-day mortality rate was 10.3%, and the overall in-hospital mortality rate was 11.9%. Eight patients (4.3%) developed new permanent neurological deficits (PNDs) including two in the non-carotid dissection group and six in the carotid dissection group. Although new PND was milder in the carotid dissection group, there was no significant difference (p = 0.248). The proportion of patients who received a coronary artery bypass graft was significantly higher in the carotid dissection group (1 vs. 8, p = 0.037).

CONCLUSIONS

According to our study, the retrograde cerebral perfusion technique is an easy and safe procedure, especially for patients with concomitant carotid dissection.