Untreated distal intimal tears may be associated with paraplegia after total arch replacement and frozen elephant trunk treatment of acute Stanford type A aortic dissection

The Journal of Thoracic and Cardiovascular Surgery

Ling Tan¹  Jun Xiao² 

[1] Department of Cardiovascular Surgery, the Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China;Department of Interventional Radiography, the Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China

关键词: acute Stanford type A aortic dissection;    total arch replacement;    frozen elephant trunk;    intimal tear;    paraplegia;   

DOI  :  10.1016/j.jtcvs.2018.08.111

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveTo investigate the possible overlooked causes of early postoperative paraplegia, a severe complication of acute Stanford type A aortic dissection (ATAAD) after total arch replacement and frozen elephant trunk (FET).MethodsWe reviewed the clinical data and perioperative aortic computed tomography angiography records of 110 consecutive patients with ATAAD who underwent total arch replacement and FET (12 cm) between December 2014 and September 2017 and investigated the possible risk factors related to early postoperative paraplegia.ResultsParaplegia occurred in 5 (4.5%) patients. No significant differences were found between patients with and without paraplegia in terms of sex, age, medical history, cardiopulmonary bypass time, antegrade cerebral perfusion time, rectal temperature during antegrade cerebral perfusion, postoperative hypotension, maximum first 24-hour vasoactive-inotropic score, upper-lower pressure gradient, or false lumen thrombosis. Postoperative aortic computed tomography angiography showed a "cutoff" phenomenon in the lower descending aorta in 4 of the 5 patients. Univariate logistical analysis showed that paraplegia was associated with the "cutoff" phenomenon (P P ConclusionsTotal arch replacement and FET is safe and feasible for ATAAD involving the descending aorta. Early postoperative paraplegia is associated with the "cutoff" phenomenon in the lower descending aorta. The position of the first untreated intimal tear may be related with the occurrence of the "cutoff" phenomenon and paraplegia.

【 授权许可】

Unknown