Abstract 4528: Aortic Repair for Acute Type A Aortic Dissection Complicated by Coma: Impact of Time From Onset on Neurological Outcome
Objectives Management of acute type A aortic dissection complicated by coma remains controversial varying from immediate aortic repair to medical management. Neurological outcome after aortic repair remains a primary concern. We analyzed our experience managing acute type A aortic dissection complicated with coma.
Methods: Between 9/03 and 5/09, 110 patients with acute type A aortic dissection were treated surgically, including 21 (19.1%) with coma (Glasgow Coma Scale <11) on arrival. In comatose patients, mean age was 72.6±12.8, prevalence of shock, pericardial effusion, and carotid dissection was 67% (14/21), 71% (15/21), and 71% (15/21), respectively. Eighteen comatose patients (86%) were repaired immediately (within 5 hours from onset of symptoms), and 3 (14%) managed initially with optimal medical management and eventual repair. For brain protection, deep hypothermic circulatory arrest with selective cerebral perfusion during procedure was selected and postoperative induced hypothermia for 48 hours was performed. Early mortality and neurological outcome were analyzed.
Results: Early mortality for acute type A aortic dissection complicated by coma was 9.5% (2/21): 5.5% (1/18) with immediate repair, and 33% (1/3) when optimal medical management with eventual repair was undertaken. Full recovery of consciousness was achieved in 81% (17/21): 89% (16/18) with immediate repair group, and 33% (1/3) with initially medically managed group. We found significant difference in the incidence of postoperative neurological morbidities between the groups. Age, presence of shock, pericardial effusion, or carotid dissection did not predict neurological outcome.
Conclusions: Aortic repair, if performed within 5 hours from onset of symptoms, showed satisfactory result for acute type A aortic dissection complicated by coma. In our patient population, timely surgical repair is strongly recommended.