Abstract：
OBJECTIVE: Type A acute aortic dissection (TAAAD) complicated with cerebral malperfusion (CM) is a life-threatening condition associated with high mortality, poor outcomes, and the optimal surgical management remains controversial. The aim of this review was to report the current results of surgical interventions of these patients.
METHODS: A systematic review was performed using PubMed and MEDLINE search for cases underwent surgical repair for TAAAD with CM. Demographics, neurological symptom, the time from onset of symptoms to operation, operation data, mortality, neurological outcome, and follow-up were reviewed.
RESULTS: A total of 363 patients with mean age of 65.7 ± 13 years underwent surgical repair for TAAAD with CM were identified in 12 retrospective studies. In-hospital mortality was 20.1%. Mean duration of follow-up was 40.1 ± 37.6 months. The involved supra-aortic branch vessels were RCCA (n = 99), LCCA (n = 25), B-CCA (n = 52), CCA (n = 131), IA (n = 19), and LSA (n = 8). Time from onset of neurological symptoms to surgery was 13.3 h. Antegrade and/or retrograde cerebral perfusion were applied. Postoperatively, improved, unchanged and worsened neurological status was occurred in 54.3%, 27.1%, and 8.5%, respectively in 199 patients.
CONCLUSIONS: The outcomes of surgical treatment of TAAAD complicated with CM indicate acceptable early mortality and morbidity. It is reasonable to perform lifesaving surgery on these patients. Early central surgical repair and reperfusion of brain may improve the outcomes.
METHODS: A systematic review was performed using PubMed and MEDLINE search for cases underwent surgical repair for TAAAD with CM. Demographics, neurological symptom, the time from onset of symptoms to operation, operation data, mortality, neurological outcome, and follow-up were reviewed.
RESULTS: A total of 363 patients with mean age of 65.7 ± 13 years underwent surgical repair for TAAAD with CM were identified in 12 retrospective studies. In-hospital mortality was 20.1%. Mean duration of follow-up was 40.1 ± 37.6 months. The involved supra-aortic branch vessels were RCCA (n = 99), LCCA (n = 25), B-CCA (n = 52), CCA (n = 131), IA (n = 19), and LSA (n = 8). Time from onset of neurological symptoms to surgery was 13.3 h. Antegrade and/or retrograde cerebral perfusion were applied. Postoperatively, improved, unchanged and worsened neurological status was occurred in 54.3%, 27.1%, and 8.5%, respectively in 199 patients.
CONCLUSIONS: The outcomes of surgical treatment of TAAAD complicated with CM indicate acceptable early mortality and morbidity. It is reasonable to perform lifesaving surgery on these patients. Early central surgical repair and reperfusion of brain may improve the outcomes.
摘要：
目的：A型急性主动脉夹层（TAAAD）并发脑灌注不良（CM）是一种危及生命的疾病，并伴有高死亡率，糟糕的结果，和最佳的手术管理仍然存在争议。这篇综述的目的是报告这些患者的手术干预的当前结果。
方法：使用PubMed和MEDLINE进行系统评价，以寻找接受CM手术修复的TAAAD病例。人口统计,神经症状,从症状发作到手术的时间，操作数据,死亡率,神经系统的结果，并对随访情况进行了回顾。
结果：在12项回顾性研究中，共363例平均年龄为65.7±13岁的患者接受了TAAAD和CM的手术修复。住院死亡率为20.1%。平均随访时间为40.1±37.6个月。受累的主动脉上分支血管为RCCA（n=99），LCCA（n=25），B-CCA（n=52），CCA（n=131），IA（n=19），和LSA(n=8)。从神经症状发作到手术的时间为13.3小时。应用顺行和/或逆行脑灌注。术后,改进,54.3%的患者出现神经状态不变和恶化，27.1%,和8.5%，分别在199名患者中。
结论：TAAAD合并CM的手术治疗结果表明早期死亡率和发病率可接受。对这些患者进行救生手术是合理的。早期的中枢手术修复和脑再灌注可以改善预后。
方法：使用PubMed和MEDLINE进行系统评价，以寻找接受CM手术修复的TAAAD病例。人口统计,神经症状,从症状发作到手术的时间，操作数据,死亡率,神经系统的结果，并对随访情况进行了回顾。
结果：在12项回顾性研究中，共363例平均年龄为65.7±13岁的患者接受了TAAAD和CM的手术修复。住院死亡率为20.1%。平均随访时间为40.1±37.6个月。受累的主动脉上分支血管为RCCA（n=99），LCCA（n=25），B-CCA（n=52），CCA（n=131），IA（n=19），和LSA(n=8)。从神经症状发作到手术的时间为13.3小时。应用顺行和/或逆行脑灌注。术后,改进,54.3%的患者出现神经状态不变和恶化，27.1%,和8.5%，分别在199名患者中。
结论：TAAAD合并CM的手术治疗结果表明早期死亡率和发病率可接受。对这些患者进行救生手术是合理的。早期的中枢手术修复和脑再灌注可以改善预后。
