INTRODUCTION
Type A acute aortic dissection (TAAAD) is a life-threatening condition associated with high mortality that requires emergency surgery. Malperfusion of aortic branch vessels is both common and catastrophic, affecting up to one-third of TAAAD cases, and strongly predicting poor outcomes [1]. Cerebral malperfusion (CM) secondary to the occlusion or stenosis of the supra-aortic trunks in TAAAD is an especially feared complication, significantly worsens survival and postoperative quality of life [2, 3]. The incidence of CM in TAAAD has been reported between 6% and 26% in single center studies [3, 4, 5, 6]. The mortality associated with the surgical management of TAAAD with CM is high, and the outcomes from previous series have been mixed. To date, the optimal management of TAAAD complicated with CM remains controversial despite numerous advances in the past decades. Coma or stroke complicating TAAAD was once considered to be an absolute contraindication to surgery [7]. Urgent surgical repair in the presence of TAAAD complicated CM can prevent the early death due to aortic rupture, organ malperfusion, or complicated acute aortic valve insufficiency, but has the risk of hemorrhagic worsening of ischemic infarction during CPB after reperfusion and before CPB and full anticoagulation. Recently, reports have applied the aggressive surgical approach for patients with TAAAD complicated with CM and shown acceptable outcomes[5, 8, 9].
The aim of the present systematic review is to investigate the current status of the management strategy of TAAAD patients complicated with CM. Understanding these outcomes is helpful for the choice of optimal management of TAAAD patients complicated with CM.