Surgical management of acute aortic dissection complicated with cerebral malperfusion

Although type A acute aortic dissection is considered a surgical emergency, the optimal treatment of patients with preoperative cerebral malperfusion remains controversial. From September 1994 to December 2005, 68 consecutive patients with type A aortic dissection underwent emergent surgical treatment. Eight patients showed preoperative newly-developed neurological deficits. The hospital mortality rate was 25% (2 of the 8 patients). Of the 8 patients, 1 with preoperative coma died due to severe brain injury. Another with acute myocardial infarction and left hemiparesis died due to low output syndrome in the immediate postoperative period. Three of the others had persistent left hemiplegia. One of these patients showed new paraplegia early postoperatively. The preoperative neurological deficit of the remaining 3 patients had improved in some degree. The optimal strategy should be taken individually under the accurate and prompt evaluations of hemodynamic and neurological state in such patients.