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

Abstract

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. 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. 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. 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.