Total arch replacement for type A aortic dissection complicated with brachiocephalic artery dissection

AIM To investigate total arch replacement for type A aortic dissection complicated with brachiocephalic artery dissection. METHODS Sixty eight patients (arch group) with type A aortic dissection (AAD) complicated with brachiocephalic artery dissection from January 2010 January 2016 were analyzed and another 60 patients with type A aortic dissection with normal brachiocephalic artery were grouped as control group. In the arch group, 38 patients had cerebral symptoms (SPT group) including two with coma, six with syncope and 25 complicated with somnolence, language and sensory disturbance and another 35 patients with no cerebral symptoms (NSPT group) in the arch group. All patients underwent total arch replacement. Clinical files from the SPT group and NSPT group were compared in terms of antegrade selective cerebral perfusion (ACP) time, frequency of arch tear, permanent neurologic deficit (PND), temporary neurologic deficit (TND), hospital death and NIHSS score before discharge from hospital. Surgical records from the arch group and control group were compared in terms of surgical time, cardiopulmonary bypass time, ACP time and cardiac arrest time, frequency of BACP and UACP, arch tear and moderate to severe aortic valve regurgitation (AR). Postoperative records from the arch group and control group were compared in terms of ICU time and frequency of re-operation for bleeding, ventilation>7 days, renal failure necessitating ultrafiltration, tracheotomy, pulmonary infection, PND and TND and hospital death. RESULTS All patients successfully achieved total arch replacement. There was no statistical difference in ACP time between SPT group and NSPT group. Compared with NSPT group, SPT group had more frequency of arch tear, permanent neurologic deficit (PND) and temporary neurologic deficit (TND), and hospital death and NIHSS score (P<0.05). Compared with control group, arch group had longer operating time, cardiopulmonary bypass time and cardiac arrest time, and more frequency of arch tear (P<0.05, P<0.01). There was no difference between arch group and control group in frequency of re-operation for bleeding, tracheotomy, postoperative renal failure needing ultrafiltration and hospital death. Compared with control group, arch group had a longer ICU time, higher frequency of long ventilation, pulmonary infection, PND and TND (P<0.05, P<0.01). CONCLUSION Surgery for AAD complicated with brachiocephalic artery dissection is complex and the incidence of postoperative cerebral complications is high. Preoperative cerebral symptoms lead to poorer prognosis.