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Brain Protection in Surgery for Acute Type A Aortic Dissection

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Controversies in Aortic Dissection and Aneurysmal Disease

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Abstract

From October 2000 to August 2012, 232 consecutive patients with acute type A aortic dissection had surgery (mean age: 66.3 ± 13.0, 21–96). All patients had surgery on an emergency or urgent basis. Thirty-four were in shock status and five required percutaneous assisted circulation. A cardiac tamponade was detected in 53 patients and a moderate or severe aortic regurgitation in 34 patients. Forty-six (19.8 %) had neurological symptom consisting with coma in 4, stroke in 12, TIA in 28, and paraplegia in 2. Fourteen patients had coronary malperfusion, 11 had visceral malperfusion, and 33 had leg malperfusion. The extent of the aortic replacement was ascending aorta in 4, hemiarch in 141, total arch in 84, total arch to descending aorta in 2, and TEVAR in 1. Aortic valve resuspension or valve repair was performed in 207, root replacement with valve sparing in 22, and Bentall procedure in 4. Brain protection was achieved by deep hypothermic circulatory arrest with or without retrograde cerebral perfusion in 78, and antegrade selective cerebral perfusion in 150. The overall hospital mortality was 13.4 % (31/232). Newly developed permanent neurological deficits occurred in 2.7 % (5/186) of patients and transient neurological dysfunction (TND) occurred in 1.6 % (3/186). There was no difference in incidence of hospital death, stroke and TND between the DHCA and ACP group also between the patients who had a hemiarch or a total arch replacement.

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Authors and Affiliations

  1. Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, 650-0072, Kobe, Hyogo, Japan

    Yutaka Okita MD, PhD, Atsushi Omura MD, PhD, Hiroya Kano PhD, Tomonori Shirasaka MD, PhD, Kenji Okada MD, PhD, Hitoshi Minami MD, Takeshi Inoue MD, Toshihito Sakamoto MD, Shunsuke Miyahara MD, Katsuhiro Yamanka MD, Taimi Ohara MD & Hidekazu Nakai MD

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  1. Yutaka Okita MD, PhD
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  2. Atsushi Omura MD, PhD
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  4. Tomonori Shirasaka MD, PhD
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Correspondence to Yutaka Okita MD, PhD .

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Editors and Affiliations

  1. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Robert S. Bonser

  2. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Domenico Pagano

  3. Thoracic and Cardiovascular Surgery Depts., Hannover Medical School, Hannover, Germany

    Axel Haverich

  4. University Hospitals Birmingham, Queen Elizabeth Hospital & Centre, Birmingham, United Kingdom

    Jorge Mascaro

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Okita, Y. et al. (2014). Brain Protection in Surgery for Acute Type A Aortic Dissection. In: Bonser, R., Pagano, D., Haverich, A., Mascaro, J. (eds) Controversies in Aortic Dissection and Aneurysmal Disease. Springer, London. https://doi.org/10.1007/978-1-4471-5622-2_26

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  • DOI: https://doi.org/10.1007/978-1-4471-5622-2_26

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  • Online ISBN: 978-1-4471-5622-2

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