Cerebral Monitoring Using Transcranial Doppler Ultrasound Improves Neurologic Outcome During Repairs of Acute Type A Aortic Dissection
A. L. Estrera, Z. Garami, C. C. Miller, E. E. Porat, T. T. Huynh, R. Sheinbaum, B. S. Allen, H. J. Safi. ,
University of Texas at Houston Medical School, Memorial Hermann Hospital, Houston, TX
BACKGROUND:
Neurologic injury following repair of Acute Type A aortic dissection remains significant. The use of transcranial doppler (TCD) to verify cerebral blood flow (CBF) during these repairs may decrease cerebral ischemia by correcting mal-perfusion. The purpose of this study was to analyze the use of TCD during repairs of acute Type A dissection with regard to neurologic outcome.
METHODS:
A prospective study of patients undergoing repairs of acute Type A aortic dissection was performed. Repairs included CPB, profound hypothermic circulatory arrest (PHCA), and retrograde cerebral perfusion (RCP). Patients in which the TCD was used to monitor CBF and modify cannulation or RCP flow during repair (Group I) were compared to those without TCD monitoring and modification (Group 2).
RESULTS:
Between 9/2001 and 10/2003, 56 cases of acute Type A dissection were repaired. TCD was used in 50% (28/56) of cases. TCD monitoring altered operative cannulation and guided RCP flow in 28.5% (8/28) and 78.6% (22/28) of cases, respectively. Two patients presented with preoperative stroke, one in each group. One operative death occurred in each group.
| Group 1(TCD) | Group 2(noTCD) | P-value |
| 30-day Mortality | 14.3% (4/28) | 28.6% (8/28) | 0.20 |
| Temporary Neurologic Deficit | 14.8% (4/27) | 51.8% (14/27) | 0.008 |
| New Stroke | 0.0% (0/27) | 7.4% (2/27) | 0.50 |
CONCLUSIONS:
By assuring cerebral blood flow using TCD, the incidence of temporary neurological injury was significantly decreased during repairs of Acute Type A aortic dissection. Using TCD for cerebral monitoring and correcting cerebral mal-perfusion may improve neurological outcome during repairs of acute Type A aortic dissection.
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