Pre-operative Cerebral Malperfusion in Patients with Acute Type A Aortic Dissection Involving the
Supra-aortic Branches: Treatment and Early Outcome
Maximilian Luehr, Christian D. Etz, Lukas Lehmkuhl,
Pascal Dohmen, Martin Misfeld, Michael A. Borger
and Friedrich W. Mohr
Objective• Acute Type A dissection may involve the supra-aortic branches causing cerebral malperfusion
• Extra-anatomic bypass to the left (LCCA) and/or right (RCCA) common carotid artery was performed to allow for complete revascularization
• Distal occlusion may occur due to thrombus formation or false lumen perfusion
Single Center Experience• Between 09/2009 and 04/2011, 81 pts with acute type A aortic dissection underwent hemiarch (n=54) or complete aortic arch (n=27) replacement
• 10 pts presented with distal occlusion of the left (LCCA) and/or right common carotid artery (RCCA)
• Extra-anatomic bypass to the LCCA (n=7) and/or the RCCA (n=4) was performed in all 10 pts
Pre-op CT scan - Distal occlusion of the RCCA or LCCA
Methods - Operative technique• After CPB initiation the distal non-dissected portion of the RCCA or LCCA was located and prepared
• A prosthetic graft was anastomosed end-to-end (-side) and unilateral antegrade selective cerebral perfusion was started
• Aortic Arch repair was continued using the island (n=1) or trifurcated graft (n=3) technique
• Hemiarch replacement was performed in 6 pts
Hemiarch replacement and LCCA bypass
Operative technique - Postop CT scan
Operative data
Results• No in-hospital mortality occurred in the 10 pts
• 1 pt developed stroke after CPR in another hospital due to significant pericardial effusion
• Transient hemiparesis occurred in 2 pts with pre-operative temporal (n=1) and frontal (n=1) lobe ischemia
• All 10 pts were alive during follow-up of 27+/-14 months
ConclusionsExtra-anatomic bypass allows for
complete re-vascularisation in cases
of acute cerebral malperfusion due
to type A aortic dissection with
involvement of the supra-aortic
branches and can be performed with
very satisfactory results
