Surgical Outcomes in Acute Type A Aortic Dissection Complicated by Coma

P0317 

Abstract Submission 

Junghun Lee (1), Noriyuki Takashima (2), Tomoaki Suzuki (3)

(1) N/A, N/A, (2) N/A, Otsu, Shiga, Japan, (3) Shiga University of Medical Science, Otsu, Shiga

Junghun Lee    -  Contact Me
N/A

Noriyuki Takashima    -  Contact Me
N/A

Tomoaki Suzuki    -  Contact Me
Shiga University of Medical Science

Junghun Lee    -  Contact Me
N/A

Objectives: The management of acute type A aortic dissection complicated by coma remains controversial. This study evaluates the surgical results of patients presenting with acute type A aortic dissection complicated by preoperative coma.
Methods: Between January 2016 to December 2019, Our institution accepted 200 patients with acute type A aortic dissection. All 200 patients underwent immediate surgery without any patient selection. Coma was defined as Glasgow Coma Scale (GCS) score of less than 11 upon arrival. The study population was divided into 2 groups comprising those with preoperative coma (Coma＋) and those without preoperative coma (Coma−). The characteristics, neurological symptoms, computed tomographic or magnetic resonance imaging scans and echocardiographic studies, interval from symptom onset to operation, and operative details (procedure, arterial cannulation site, method of brain protection) were retrospectively reviewed and compared by univariable and multivariable analyses.
Results: There were 30 patients (15.0%, 30/200) admitted with coma. there were no significant differences except that males were significantly less prevalent in the Coma+ group and that the median interval from onset to the start of surgery was significantly shorter in the Coma+ group (2.8 hours, 2.9-5.1 vs. 3.7 hours, 2.0-4.5; P = .017). In terms of preoperative data related to aortic dissection, shock, cardiac tamponade, intubation upon arrival, cardiopulmonary arrest, and visceral malperfusion were significantly more prevalent in Coma＋ patients. Preoperative CT angiography revealed a significantly higher incidence of dissection involving supra-aortic vessels in Coma＋ patients. There were no significant differences in almost all operative data, except that femoral arterial cannulation was significantly more prevalent in the Coma+ group. When comparing postoperative data, there was a significantly higher incidence of postoperative neurologic injury (14/30, 46.7% vs. 23/170, 13.5%; P < .001) and multiple organ failure (6/30, 20.0% vs. 5/170, 2.9%; P = .002) in the Coma+ group. Postoperative stroke was significantly more prevalent in in the Coma+ group (14/30, 46.7% vs. 20/170, 11.8%; P < .001). However, 60.0% (18 of 30) experienced recovery of consciousness in the GCS score and 46.7% (14 of 30) experienced full recovery after surgery. Multivaribale analysis identified preoperative coma (odds ratio, 12.183; 95% confidence interval, 3.368-44.067) as an independent predictor for in-hospital mortality. Preoperative coma was associated with impaired survival (P < .001).
Conclusions: Coma was associated with high mortality after surgery. However, full recovery was observed in approximately half of the patients with preoperative coma. Immediate surgical repair is warranted even when acute type A aortic dissection is complicated by preoperative coma.

Dissection