1 / 10

Maximilian Luehr , Christian D. Etz, Lukas Lehmkuhl,

Maximilian Luehr , Christian D. Etz, Lukas Lehmkuhl, Pascal Dohmen, Martin Misfeld, Michael A. Borger and Friedrich W. Mohr. Pre-operative Cerebral Malperfusion in Patients with Acute Type A Aortic Dissection Involving the Supra-aortic Branches: Treatment and Early Outcome. Objective .

lora
Download Presentation

Maximilian Luehr , Christian D. Etz, Lukas Lehmkuhl,

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Maximilian Luehr, Christian D. Etz, Lukas Lehmkuhl, Pascal Dohmen, Martin Misfeld, Michael A. Borger and Friedrich W. Mohr Pre-operative Cerebral Malperfusion in Patients with Acute Type A Aortic Dissection Involving the Supra-aortic Branches: Treatment and Early Outcome

  2. Objective • Acute Type A dissection may involve the supra-aortic branches causing cerebral malperfusion • Distal occlusion may occur due to thrombus formation or false lumen perfusion • Extra-anatomic bypass to the left (LCCA) and/or right (RCCA) common carotid artery was performed to allow for complete revascularization

  3. 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

  4. Pre-op CT scan - Distal occlusion of the RCCA or LCCA

  5. 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

  6. Hemiarch replacement and LCCA bypass

  7. Operative technique - Postop CT scan

  8. Operative data

  9. Results • No in-hospital mortality occurred in the 10 pts • Transient hemiparesis occurred in 2 pts with pre-operative temporal (n=1) and frontal (n=1) lobe ischemia • 1 pt developed stroke after CPR in another hospital due to significant pericardial effusion • All 10 pts were alive during follow-up of 27+/-14 months

  10. Conclusions Extra-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

More Related