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.