Abstract
Background. Syncope or new onset focal neurologic deficits are described in as many as one fifth of patients with acute aortic dissection referred for surgery. Coma or stroke caused by involvement of the arch vessels and secondary brain malperfusion is considered a major contraindication for emergency aortic repair. Initial experience with emergency operation in selected patients with acute type A aortic dissection complicated by coma is described. Methods. Five comatose (median Glasgow coma score, 5.5), hemodynamically stable (systolic blood pressure ≥ 100 mm Hg) patients with preserved pupillary reactivity and coma duration of less than 12 hours underwent emergency surgical repair. The ascending aorta was always replaced using profound hypothermic circulatory arrest. Results. There were no operative deaths. No hemorrhagic brain infarction developed postoperatively. Ischemic strokes were documented by radiology in 3 patients, and were always right-sided. Four patients returned to normal life with no neurologic sequelae, whereas 1 patient showed partially recovered left hemiparesis and mild cognitive impairment. Conclusions. Coma may not represent an absolute contraindication for resuscitative surgery in hemodynamically stable patients with acute type A aortic dissection. A larger experience is necessary to draw more definitive conclusions.
| Original language | English |
|---|---|
| Pages (from-to) | 1348-1351 |
| Number of pages | 4 |
| Journal | Annals of Thoracic Surgery |
| Volume | 81 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2006 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
Cite this
Coma might not preclude emergency operation in acute aortic dissection. / Pocar, Marco; Passolunghi, Davide; Moneta, Andrea; Mattioli, Roberto; Donatelli, Francesco.
In: Annals of Thoracic Surgery, Vol. 81, No. 4, 04.2006, p. 1348-1351.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Coma might not preclude emergency operation in acute aortic dissection
AU - Pocar, Marco
AU - Passolunghi, Davide
AU - Moneta, Andrea
AU - Mattioli, Roberto
AU - Donatelli, Francesco
PY - 2006/4
Y1 - 2006/4
N2 - Background. Syncope or new onset focal neurologic deficits are described in as many as one fifth of patients with acute aortic dissection referred for surgery. Coma or stroke caused by involvement of the arch vessels and secondary brain malperfusion is considered a major contraindication for emergency aortic repair. Initial experience with emergency operation in selected patients with acute type A aortic dissection complicated by coma is described. Methods. Five comatose (median Glasgow coma score, 5.5), hemodynamically stable (systolic blood pressure ≥ 100 mm Hg) patients with preserved pupillary reactivity and coma duration of less than 12 hours underwent emergency surgical repair. The ascending aorta was always replaced using profound hypothermic circulatory arrest. Results. There were no operative deaths. No hemorrhagic brain infarction developed postoperatively. Ischemic strokes were documented by radiology in 3 patients, and were always right-sided. Four patients returned to normal life with no neurologic sequelae, whereas 1 patient showed partially recovered left hemiparesis and mild cognitive impairment. Conclusions. Coma may not represent an absolute contraindication for resuscitative surgery in hemodynamically stable patients with acute type A aortic dissection. A larger experience is necessary to draw more definitive conclusions.
AB - Background. Syncope or new onset focal neurologic deficits are described in as many as one fifth of patients with acute aortic dissection referred for surgery. Coma or stroke caused by involvement of the arch vessels and secondary brain malperfusion is considered a major contraindication for emergency aortic repair. Initial experience with emergency operation in selected patients with acute type A aortic dissection complicated by coma is described. Methods. Five comatose (median Glasgow coma score, 5.5), hemodynamically stable (systolic blood pressure ≥ 100 mm Hg) patients with preserved pupillary reactivity and coma duration of less than 12 hours underwent emergency surgical repair. The ascending aorta was always replaced using profound hypothermic circulatory arrest. Results. There were no operative deaths. No hemorrhagic brain infarction developed postoperatively. Ischemic strokes were documented by radiology in 3 patients, and were always right-sided. Four patients returned to normal life with no neurologic sequelae, whereas 1 patient showed partially recovered left hemiparesis and mild cognitive impairment. Conclusions. Coma may not represent an absolute contraindication for resuscitative surgery in hemodynamically stable patients with acute type A aortic dissection. A larger experience is necessary to draw more definitive conclusions.
UR - http://www.scopus.com/inward/record.url?scp=33645344097&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33645344097&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2005.09.076
DO - 10.1016/j.athoracsur.2005.09.076
M3 - Article
C2 - 16564270
AN - SCOPUS:33645344097
VL - 81
SP - 1348
EP - 1351
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 4
ER -