Abstract 19236: Late Outcomes Following Immediate Aortic Repair for Acute Type A Aortic Dissection Complicated by Coma
Objectives: Management of acute type A aortic dissection complicated by coma remains controversial. We previously reported an excellent recovery of consciousness for patients with coma if aortic repair performed within 5 hours from onset of symptoms. This study evaluates the early and late outcomes with this approach.
Methods: Between 9/03 and 5/10, 132 patients with acute type A aortic dissection were treated surgically, including 22 (16.7%) presented with coma (Glasgow Coma Scale <11) on arrival. Nineteen patients (86%) were repaired immediately; time from onset of symptoms to operating room less than 5 hours. The mean age of the patients with immediate aortic repair was 70.9 (SD 13.1) years, and prevalence of shock and carotid dissection was 58% (11/19), and 74% (14/19), respectively. Neurological deficit, such as hemiplegia or concomitant deviation of eyes, coexisted in 74% (14/19). For brain protection, deep hypothermia with antegrade cerebral perfusion was utilized and postoperative induced hypothermia for 48 hours was performed.
Results: Time from onset of symptoms to operating room was 199 (SD 59) minutes. Hospital mortality of the comatose patients who had immediate aortic repair was 5.3% (1/19) and that was equivalent to the mortality of the entire cohort (n = 132: 8.3%). Full recovery of consciousness was achieved in 84% (16/19) in 14 days after repair, and the incidence of coexisted neurological deficits was significantly decreased postoperatively (42%: 8/19). The mean follow-up periods was 34.5 (SD 25.1) months. Cumulative survival rate was 71.8% in 3 years, and ADL independence was achieved in 67% (10/15).
Conclusions: Early and late outcomes following the strategy of immediate aortic repair, performed within 5 hours from onset of symptoms, for acute type A aortic dissection complicated by coma were satisfactory. Timely surgical repair is strongly recommended.
- © 2010 by American Heart Association, Inc.