Extra-anatomic revascularization and a new cannulation strategy for preoperative cerebral malperfusion due to severe stenosis or occlusion of supra-aortic branch vessels in acute type A aortic dissection
Jingwei Sun,
Chao Xue,
Jinglong Zhang,
Chen Yang,
Kai Ren,
Hanzhao Zhu,
Bin Zhang,
Xiayun Li,
Hongliang Zhao,
Zhenxiao Jin,
Jincheng Liu,
Weixun Duan
Affiliations
Jingwei Sun
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
Chao Xue
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
Jinglong Zhang
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
Chen Yang
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
Kai Ren
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
Hanzhao Zhu
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
Bin Zhang
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
Xiayun Li
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
Hongliang Zhao
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
Zhenxiao Jin
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
Jincheng Liu
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Corresponding author. Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, 710032, Shaanxi, China.
Weixun Duan
Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China; Corresponding author. Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi'an, 710032, Shaanxi, China.
Objectives: Acute type A aortic dissection (ATAAD) with severe stenosis or occlusion of the true lumen of aortic arch branch vessels often leads to an increased incidence of severe postsurgical neurological complications and mortality rate. In this study, we aimed to introduce our institutional extra-anatomic revascularization and cannulation strategy with improved postoperative outcomes for better management of patients with cerebral malperfusion in the setting of ATAAD. Methods: Twenty-eight patients with ATAAD complicated by severe stenosis or occlusion of the aortic arch branch vessels, as noted on combined computed tomography angiography of the aorta and craniocervical artery, between January 2021 and June 2022 were included in this study. Basic patient characteristics, surgical procedures, hospitalization stays, and early follow-up results were analyzed. Results: The median follow-up duration was 16.5 months (interquartile range: 11.5–20.5), with a 100% completion rate. The 30-day mortality rates was 7.1% (2/28 patients); two patients had multiple cerebral infarctions on preoperative computed tomography and persistent coma. Postoperative transient neurological dysfunction occurred in 10.7% (3/28) of the patients, and no new permanent neurological dysfunction occurred. Of all the patients, 3.6% (1/28) had novel acute renal failure. No other deaths, secondary surgeries, or serious complications occurred during the early follow-up period. Conclusions: Use of extra-anatomic revascularization and a new cannulation strategy before cardiopulmonary bypass is safe and feasible and may reduce the high incidence of postoperative neurological complications in patients with ATAAD and cerebral malperfusion.
