Does Aggressive Reconstruction of Dissected Neck Artery Prevent Postoperative Stroke in Patients with Type A Aortic Dissection?

Shinji Masuyama, Tetsuya Ichihara, Takehiko Inoue

Department of Cardiovascular Surgery, Ohtakanomori Hospital, Kashiwa, Japan

Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–B

Abstract

Introduction: Stroke is a severe complication of type A acute aortic dissection. Prediction of stroke development after surgical reconstruction of aortic dissection is difficult. We examined whether preoperative neck vessel (NV) dissection is associated with postoperative stroke and mortality and whether aggressive NV reconstruction can prevent stroke.

Method: We analyzed 97 cases of surgical reconstruction of type A acute aortic dissection performed from December 2014 to November 2017. According to our policy, the intimal tear of the dissection must be perfectly excluded if the tear can be recognized in the field of view. However, the area of replacement is determined by the site of the intimal tear, not the extension of the NV dissection. In all patients, selective NV perfusion was performed during circulatory arrest with mild hypothermia.

Results: We compared patients with and without preoperative NV dissection [Group A (n=60) and B (n=37), respectively]. Postoperatively, the incidence of stroke (as indicated by computed tomography findings or symptoms) and mortality were significantly higher in Group A than B (46% vs. 21%, p<0.01 and 23% vs. 1%, respectively). Two subgroups were compared within Group A: those who underwent ascending aorta replacement (ASR) and those who underwent hemi-arch replacement for NV dissection repair (HAR). The aortic clamp time and circulatory arrest time were longer in the HAR than ASR group (157±10 vs. 124±7 min, p<0.01 and 53±3 vs. 38±1 min, p<0.01, respectively). Postoperatively, the incidence of stroke tended to be lower in the ASR than HAR group (42% vs. 62%, p=0.22).

Conclusion: Postoperative stroke is a potential complication in patients with type A acute aortic dissection and computed tomography-confirmed NV dissection. In patients with NV dissection, HAR did not lead to stroke prevention based on the prolonged aortic clamp time and circulatory arrest time. Therefore, aggressive NV reconstruction cannot prevent stroke.