Early Cerebral Reperfusion in Acute Aortic Dissection

Background: Acute Type A Aortic Dissection (ATAAD) is a life-threatening and rapidly progressing condition if left untreated. Surgery has shown a survival benefit over medical therapy but postoperative outcome depends on careful evaluation of preoperative parameters especially organ malperfusion. It is not uncommon for ATAAD to involve the supraaortic branches leading to preoperative cerebral malperfusion. We present a novel approach to early cerebral reperfusion in patients with preoperative neurological symptoms and verified cerebral malperfusion.

Methods: Patients presenting with ATAAD affecting the supraaortic branches with verified cerebral malperfusion who were eligible for open surgical repair received a direct cannulation of one common carotid artery (CCA) distal to the dissection. This additional perfusion branch was connected to cardiopulmonary bypass (CPB) via Y-connector allowing for simultaneous perfusion of the left subclavian as well as the left or right CCA. Intraoperative success was measured by cerebral blood oxygenation. After completion of the aortic repair and weaning of CPB the carotid bypass graft was tunneled into the mediastinum and anastomosed to the ascending aortic prosthesis. Extensive postoperative neurological examination and CT angiography were performed for validation of surgical success and evaluation of postoperative neurological complications.

Results: Immediate intraoperative results revealed a rapid increase in cerebral blood oxygenation as soon as the anastomosis was completed and connected to the cardiopulmonary bypass. Postoperative CT angiography confirmed optimal aortic repair and effective cerebral perfusion via carotid bypass graft. Neurological examination on discharge indicated no cognitive impairment.

Conclusion: Our novel approach to cerebral reperfusion in patients with ATAAD and preoperative cerebral malperfusion demonstrates a promising advancement in managing this critical condition. By employing direct cannulation of a CCA and utilizing a Y-connector for simultaneous perfusion, we effectively addressed the limitations of traditional CPB methods in ATAAD and cerebral malperfusion. The subsequent postoperative evaluations affirmed the success of this intervention and provided valuable insights into its impact on neurological outcomes. This approach could potentially enhance survival rates and reduce neurological complications in patients with complex ATAAD, warranting further research and broader clinical application.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025