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SHOULD NEUROLOGIC SYMPTOMS STILL PRECLUDE SURGERY IN ACUTE TYPE A AORTIC DISSECTION? Free

Objectives: Severe neurological deficit due to acute aortic dissection type A (AADA) is considered as a contraindication for surgery because of poor prognosis. Recently, more liberal indication for surgery despite neurological symptoms has shown acceptable clinical results. We evaluated the mid-term outcome of patients with AADA presenting with severe neurological deficit prior to operation.

Methods: Out of 314 patients who underwent surgical repair for AADA between 2005 and 2012, we retrospectively reviewed the 53 patients presenting with acute neurological deficit, such as focal motor or sensory deficit, convulsions or coma. Neurological symptoms were evaluated using Glasgow Coma Scale (GCS), Modified Rankin Scale (MRS) and National Institutes of Health Stroke Scale (NIHSS), preoperatively, at discharge and 3–6 months after surgery. Dissection or occlusion of cerebral vessels was assessed in the preoperative and postoperative CT scan.

Results: Of the 53 patients, 54.7% (29) showed complete recovery from neurological deficit at follow-up. Neurological symptoms persisted in 45.3% (24) of patients, of which 8 died without neurological assessment at follow-up. Between the groups there was no significant difference regarding age (58.6 ± 13 vs 61 ± 10.5 years), gender (62% vs 71% male) or duration of deep hypothermic circulatory arrest (28 ± 14 vs 36 ± 20 min). Multivariate analysis showed significant differences for the preoperative MRS between the two groups (P < 0.007). Logistic regression analysis revealed high preoperative MRS to be predictive for persistence of neurological symptoms (P < 0.02).

Conclusion: A total of 54% of patients recovered completely from neurological deficit, and its severity has predictive value for recovery. Neurological deficit in patients with AADA should not generally preclude emergency surgery.