Stroke after emergent surgery for acute type A aortic dissection: Predictors, outcome and neurological recovery

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Dumfarth J, et al. – Researchers aimed at identifying the predictors for stroke after emergent surgery for acute type A aortic dissection. In addition, they analyzed the impact on morbidity, neurological recovery and mid-term survival. Independent preoperative predictors for postoperative stroke were recognized. Despite an association of postoperative stroke with significant morbidity and postoperative complications, data could not confirm a significant impairment in mid-term survival. Data revealed that postoperative stroke was associated with significant morbidity and postoperative complications, however, its association with significant impairment in mid-term survival could not be confirmed.

Methods

  • Three hundred and three (71.9% men, mean age 58.9 ± 13.6 years) patients with acute type A aortic dissection underwent surgical repair from 2000 and 2017.
  • Retrospective evaluation of clinical and imaging data was performed.
  • Depending on the presence of postoperative stroke, patients were divided into 2 groups.
  • Results
  • In 15.8% (n = 48) of the patients, researchers detected postoperative stroke.
  • Among patients with postoperative stroke, higher rates of preoperative cardiopulmonary resuscitation (stroke: 18.8% vs no stroke: 3.5%, P < 0.001) and malperfusion syndrome (stroke: 47.9% vs no stroke: 22.4%, P < 0.001) were evident.
  • As per multivariable analysis, independent predictors for postoperative stroke included the presence of bovine aortic arch [odds ratio (OR) 2.33, 95% confidence interval (CI) 1.086–4.998; P=0.030], preoperative cardiopulmonary resuscitation (OR 6.483, 95% CI 1.522–27.616; P=0.011) and preoperative malperfusion (OR 2.536, 95% CI 1.238–5.194; P=0.011).
  • Postoperative stroke was found to have a strong impact on morbidity and was correlated with greater rates of postoperative complications and a markedly longer hospital stay (stroke: 23 ± 16 days vs no stroke: 17 ± 18 days, P=0.021).
  • No independent association was observed between postoperative stroke and in-hospital mortality (adjusted OR 1.382, 95% CI 0.518–3.687; P=0.518).
  • Patients with stroke and patients without stroke showed no difference in terms of mid-term survival.
 

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