JTCS Email Content Delivery
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Anthony L. Estrera
Eyal E. Porat
Paul E. Achouh
Jayesh Dhareshwar
Riad Meada
Hazim J. Safi
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Estrera, A. L.
Right arrow Articles by Safi, H. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Estrera, A. L.
Right arrow Articles by Safi, H. J.
Related Collections
Right arrow Cerebral protection
Right arrow Extracorporeal circulation
Right arrow Great vessels

J Thorac Cardiovasc Surg 2006;132:1404-1408
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Acute type A aortic dissection complicated by stroke: Can immediate repair be performed safely?

Anthony L. Estrera, MDa,*, Zsolt Garami, MDb, Charles C. Miller, PhDa, Eyal E. Porat, MDa, Paul E. Achouh, MDa, Jayesh Dhareshwar, MDa, Riad Meada, MDa, Ali Azizzadeh, MDa, Hazim J. Safi, MDa

a Department of Cardiothoracic and Vascular Surgery, The University of Texas-Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, Tex
b Department of Neurology, The University of Texas-Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, Tex.

Received for publication May 11, 2006; revisions received June 27, 2006; accepted for publication July 12, 2006.

* Address for reprints: Anthony L. Estrera, MD, Department of Cardiothoracic and Vascular Surgery, The University of Texas-Houston Medical School, 6410 Fannin St, Suite 450, Houston, TX 77030 (Email: Anthony.l.estrera{at}uth.tmc.edu).

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 < .02).

CONCLUSIONS: In our experience, surgical repair of acute type A aortic dissection can be performed in the setting of preoperative stroke with acceptable mortality. Moreover, no worsening of neurologic condition was observed after surgical repair. Immediate surgical repair is warranted even if acute type A aortic dissection is complicated by stroke.

Abbreviations and Acronyms CT = computed tomography; NIHSS = National Institutes of Health Stroke Scale; PM-TCD = power M-mode transcranial Doppler ultrasound




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. Zegdi, B. Amahzoune, P. Achouh, C. Latremouille, A. Deloche, and J.-N. Fabiani
Periaortic glue application may prevent fatal aortic rupture in nonoperable patients with acute type A aortic dissection.
J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1349 - 1350.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
A. Geirsson, W. Y. Szeto, A. Pochettino, M. L. McGarvey, M. G. Keane, Y. J. Woo, J. G. Augoustides, and J. E. Bavaria
Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations
Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 255 - 262.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Pocar, D. Passolunghi, A. Moneta, and F. Donatelli
Immediate surgery in aortic dissection with cerebral malperfusion
J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1684 - 1685.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. L. Estrera and H. J. Safi
Reply to the Editor
J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1685 - 1685.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The American Association for Thoracic Surgery.