Thorac Cardiovasc Surg 2018; 66(S 01): S1-S110
DOI: 10.1055/s-0038-1628052
Oral Presentations
Tuesday, February 20, 2018
DGTHG: Aorta IV – Dissection
Georg Thieme Verlag KG Stuttgart · New York

Stroke after Emergent Surgery for Acute Type A Aortic Dissection: Predictors, Outcome, and Neurologic Recovery

J. Dumfarth
1   Universitätsklinik für Herzchirurgie, Universitätsklinik Innsbruck, Innsbruck, Austria
,
M. Kofler
1   Universitätsklinik für Herzchirurgie, Universitätsklinik Innsbruck, Innsbruck, Austria
,
L. Stastny
1   Universitätsklinik für Herzchirurgie, Universitätsklinik Innsbruck, Innsbruck, Austria
,
M. Plaikner
2   Universitätsklinik für Radiologie, Universitätsklinik Innsbruck, Innsbruck, Austria
,
C. Krapf
1   Universitätsklinik für Herzchirurgie, Universitätsklinik Innsbruck, Innsbruck, Austria
,
S. Semsroth
1   Universitätsklinik für Herzchirurgie, Universitätsklinik Innsbruck, Innsbruck, Austria
,
M. Grimm
1   Universitätsklinik für Herzchirurgie, Universitätsklinik Innsbruck, Innsbruck, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

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Objectives: Despite improvement in operative and cerebral perfusion techniques, cerebral malperfusion and neurologic injury remain a dreaded complication of acute type A aortic dissection (AAD). Aim of this study was, to identify predictors for postoperative stroke and analyze the impact on morbidity, neurologic recovery and mid-term survival.

Methods: Between 2000 and 2017, 303 patients (71.9% male, mean age 58.9 ± 13.6 years) suffering from AAD underwent surgical repair. Clinical and imaging data were retrospectively evaluated. Patients were divided into two groups depending on presence of postoperative stroke.

Results: Postoperative stroke was detected in 15.8% (n = 48). Patients with postoperative stroke showed higher rates of preoperative cardiopulmonary resuscitation (CPR) (stroke: 18.8% vs. (vs) no stroke: 3.5%, p < 0.001) and malperfusion (stroke: 47.9% vs. no stroke: 22.4%, p < 0.001). Multivariable analysis identified presence of bovine aortic arch (OR 2.33, 95%CI 1.086–4.998, p = 0.030), preoperative CPR (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) as independent predictors for postoperative stroke. Postoperative stroke had clear impact on morbidity and was associated with higher rates of postoperative complications and a significantly longer hospital stay (stroke: 23 ± 16 days vs. no stroke: 17 ± 18 days, p = 0.021). Postoperative stroke was not independently associated with in hospital mortality (adjusted OR 1.382, 95%CI 0.518–3.687, p = 0.518). There was no difference in mid-term survival between patients with and without stroke.

Conclusion: This study identified independent preoperative predictors for postoperative stroke. Postoperative stroke is association with tremendous morbidity and postoperative complications. Despite a trend toward higher hospital mortality, postoperative stroke surprisingly does not have an impact on mid-term survival.