Direct perfusion of the carotid artery in patients with brain malperfusion secondary to acute aortic dissection

OBJECTIVE

Presenting our experience of direct perfusion of the carotid artery in patients with brain malperfusion secondary to acute aortic dissection.

PATIENTS

Among 381 patients who underwent aortic repair for acute type A aortic dissection from October 1999 to August 2017, brain malperfusion was recognized in 50 patients. Nine patients had direct perfusion of the right carotid artery in patients with brain malperfusion secondary to acute aortic dissection. Age at surgery was 65.7 ± 13.5 years and three patients were male. Preoperative consciousness level was alert in one patients, drowsy in six, and coma in two. Five patients had preoperative hemiplegia. All patients showed a blood pressure difference between the upper extremities and eight patients showed more than 15% difference of rSO₂. Seven patients had a temporary external active shunt from the femoral artery to the right common carotid artery preoperatively. Two patients had direct perfusion to the right common carotid artery during cardiopulmonary bypass or in the intensive care unit after surgery because of a sudden decrease of rSO₂ and cessation of carotid artery flow. Antegrade cerebral perfusion was used in all patients. Total arch replacement was performed in six patients and hemiarch in three.

RESULTS

The hospital mortality was 33% (3 patients). Causes of death were huge hemispheric brain infarction or anoxic brain damage in two patients and myocardial infarction in one. The postoperative neurological outcome was alert in four, hemiplegia in two, and coma in three, but five patients showed some improvement of neurological signs.

CONCLUSION

Aggressive direct reperfusion of the carotid artery before the aortic repair may reduce neurological complications in patients with preoperative brain malperfusion secondary to acute aortic dissection.