Intentional Surgical Delay in Acute Type A Aortic Dissection With Cerebral Malperfusion.

BACKGROUND

The management of acute type A aortic dissection complicated by cerebral malperfusion remains a major clinical challenge, with no clear consensus on the optimal treatment strategy. Because immediate open surgical repair predominates contemporary practice, intentional surgical delay has been rarely reported.

METHODS

This report describes 2 cases of acute type A aortic dissection complicated by cerebral malperfusion that were managed through intentional surgical delay. In both patients, open proximal aortic repair was deferred for 5 months and was performed only after neurologic recovery or stabilization.

RESULTS

Patient 1 was discharged on postoperative day 11 with preserved neurologic function, whereas patient 2 was discharged on postoperative day 21 without new neurologic deficits.

CONCLUSIONS

These cases suggest that intentional surgical delay may represent a feasible and potentially beneficial treatment strategy in carefully selected patients with acute type A aortic dissection complicated by cerebral malperfusion.