Early and late outcomes of type A acute aortic dissection with common carotid artery involvementCentral MessagePerspective
Objective: The relationship between common carotid artery (CCA) involvement in acute type A aortic dissection (ATAAD) and postoperative outcomes remains unclear. We investigated outcomes and described our current advanced strategy. Methods: Of 492 patients who underwent surgical repair for ATAAD bet...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273622000729 |
| _version_ | 1818214335870140416 |
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| author | Taishi Inoue, MD Atsushi Omura, MD, PhD Shunya Chomei, MD Hidekazu Nakai, MD Katsuhiro Yamanaka, MD, PhD Takeshi Inoue, MD Kenji Okada, MD, PhD |
| author_facet | Taishi Inoue, MD Atsushi Omura, MD, PhD Shunya Chomei, MD Hidekazu Nakai, MD Katsuhiro Yamanaka, MD, PhD Takeshi Inoue, MD Kenji Okada, MD, PhD |
| author_sort | Taishi Inoue, MD |
| collection | DOAJ |
| description | Objective: The relationship between common carotid artery (CCA) involvement in acute type A aortic dissection (ATAAD) and postoperative outcomes remains unclear. We investigated outcomes and described our current advanced strategy. Methods: Of 492 patients who underwent surgical repair for ATAAD between September 1999 and February 2021, CCA involvement was identified in 114. Eighty of these 114 patients (70.2%) were classified as having a thrombosed CCA and 34 (29.8%) were classified as nonthrombosed. To prevent postoperative cerebral malperfusion, we initiated a strategy of early reperfusion and direct reconstruction of dissected and thrombosed CCAs regardless of neurologic symptoms. Results: Fifty-five patients (48.2%) showed preoperative neurologic symptoms. No significant differences between the thrombosed and nonthrombosed groups were seen in postoperative mortality (20.0% vs 11.8%; P = .421) or frequency of postoperative modified Rankin scale (mRS) score ≥5 (30.0% vs 17.6%; P = .245). The rate of postoperative neurologic deficit was significantly higher (48.8% vs 23.5%; P = .013) and long-term survival rate was significantly lower (5 years; 59.1 ± 6.3% vs 77.9 ± 7.4%; 10 years: 50.0 ± 7.9% vs 72.3 ± 8.7%; P = .041) in the thrombosed group. Risk factors for mRS ≥5 from multivariable analysis included occluded thrombosed CCA, preoperative coma, preoperative shock, and prolonged operation time. Fifteen patients were treated with the early reperfusion and direct reconstruction strategy; postoperative mortality 13.3% (2 patients). No patients showed cerebral reperfusion syndrome. Conclusions: In patients with CCA involvement, a thrombosed false lumen, especially an occluded CCA, resulted in worse outcomes regardless of preoperative neurologic symptoms. Further study is needed to evaluate the efficacy of the current strategy. |
| first_indexed | 2024-12-12T06:18:33Z |
| format | Article |
| id | doaj.art-512f55db9a59406f84a9da261e5f4a77 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-12-12T06:18:33Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-512f55db9a59406f84a9da261e5f4a772022-12-22T00:34:58ZengElsevierJTCVS Open2666-27362022-06-0110111Early and late outcomes of type A acute aortic dissection with common carotid artery involvementCentral MessagePerspectiveTaishi Inoue, MD0Atsushi Omura, MD, PhD1Shunya Chomei, MD2Hidekazu Nakai, MD3Katsuhiro Yamanaka, MD, PhD4Takeshi Inoue, MD5Kenji Okada, MD, PhD6Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, JapanDivision of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, JapanDivision of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, JapanDivision of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, JapanDivision of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, JapanDivision of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, JapanAddress for reprints: Kenji Okada, MD, PhD, Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.; Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, JapanObjective: The relationship between common carotid artery (CCA) involvement in acute type A aortic dissection (ATAAD) and postoperative outcomes remains unclear. We investigated outcomes and described our current advanced strategy. Methods: Of 492 patients who underwent surgical repair for ATAAD between September 1999 and February 2021, CCA involvement was identified in 114. Eighty of these 114 patients (70.2%) were classified as having a thrombosed CCA and 34 (29.8%) were classified as nonthrombosed. To prevent postoperative cerebral malperfusion, we initiated a strategy of early reperfusion and direct reconstruction of dissected and thrombosed CCAs regardless of neurologic symptoms. Results: Fifty-five patients (48.2%) showed preoperative neurologic symptoms. No significant differences between the thrombosed and nonthrombosed groups were seen in postoperative mortality (20.0% vs 11.8%; P = .421) or frequency of postoperative modified Rankin scale (mRS) score ≥5 (30.0% vs 17.6%; P = .245). The rate of postoperative neurologic deficit was significantly higher (48.8% vs 23.5%; P = .013) and long-term survival rate was significantly lower (5 years; 59.1 ± 6.3% vs 77.9 ± 7.4%; 10 years: 50.0 ± 7.9% vs 72.3 ± 8.7%; P = .041) in the thrombosed group. Risk factors for mRS ≥5 from multivariable analysis included occluded thrombosed CCA, preoperative coma, preoperative shock, and prolonged operation time. Fifteen patients were treated with the early reperfusion and direct reconstruction strategy; postoperative mortality 13.3% (2 patients). No patients showed cerebral reperfusion syndrome. Conclusions: In patients with CCA involvement, a thrombosed false lumen, especially an occluded CCA, resulted in worse outcomes regardless of preoperative neurologic symptoms. Further study is needed to evaluate the efficacy of the current strategy.http://www.sciencedirect.com/science/article/pii/S2666273622000729aortic dissectioncarotid arterymalperfusion syndromestrokecerebral perfusion |
| spellingShingle | Taishi Inoue, MD Atsushi Omura, MD, PhD Shunya Chomei, MD Hidekazu Nakai, MD Katsuhiro Yamanaka, MD, PhD Takeshi Inoue, MD Kenji Okada, MD, PhD Early and late outcomes of type A acute aortic dissection with common carotid artery involvementCentral MessagePerspective JTCVS Open aortic dissection carotid artery malperfusion syndrome stroke cerebral perfusion |
| title | Early and late outcomes of type A acute aortic dissection with common carotid artery involvementCentral MessagePerspective |
| title_full | Early and late outcomes of type A acute aortic dissection with common carotid artery involvementCentral MessagePerspective |
| title_fullStr | Early and late outcomes of type A acute aortic dissection with common carotid artery involvementCentral MessagePerspective |
| title_full_unstemmed | Early and late outcomes of type A acute aortic dissection with common carotid artery involvementCentral MessagePerspective |
| title_short | Early and late outcomes of type A acute aortic dissection with common carotid artery involvementCentral MessagePerspective |
| title_sort | early and late outcomes of type a acute aortic dissection with common carotid artery involvementcentral messageperspective |
| topic | aortic dissection carotid artery malperfusion syndrome stroke cerebral perfusion |
| url | http://www.sciencedirect.com/science/article/pii/S2666273622000729 |
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