Surgery for Type A Aortic Dissection in Patients with Cerebral Malperfusion: Results From the International Registry of Acute Aortic Dissections

The International Registry of Acute Aortic Dissection investigators analyzed the impact of cerebral malperfusion (CM) on the surgical outcomes of acute type A dissection in 2402 patients. The incidence of CM and neurologic deficit was 15.1% (362/2402). While patients with CM were less likely to present with chest pain and back pain, they had a significantly higher incidence of syncope, peripheral malperfusion, and shock and were more likely to have Debakey type I dissection and pericardial effusion on presentation. In-hospital mortality and the incidences of cerebrovascular accident and acute kidney injury were significantly higher in patients with CM. The authors conclude that surgeons may continue to offer lifesaving surgery for acute type A dissection to this critically ill cohort of patients with acceptable morbidity and mortality.