1. Immediate Surgery in Acute Type A Dissection and Neurologic Dysfunction: Fighting the Inevitable?
- Author
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Dumfarth J, Kofler M, Stastny L, Gasser S, Plaikner M, Semsroth S, Krapf C, Schachner T, Bonaros N, and Grimm M
- Subjects
- Adult, Aged, Aortic Dissection complications, Aortic Dissection diagnostic imaging, Aortic Dissection physiopathology, Aortic Aneurysm complications, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm physiopathology, Aortography, Brain Ischemia diagnostic imaging, Brain Ischemia prevention & control, Carotid Arteries diagnostic imaging, Cerebrovascular Circulation, Coma etiology, Computed Tomography Angiography, Consciousness Disorders prevention & control, Diabetes Complications, Female, Hemodynamics, Humans, Hypertension complications, Kaplan-Meier Estimate, Length of Stay, Male, Middle Aged, Postoperative Complications prevention & control, Preoperative Care, Propensity Score, Retrospective Studies, Risk Factors, Aortic Dissection surgery, Aortic Aneurysm surgery, Brain Ischemia etiology, Consciousness Disorders etiology, Postoperative Complications etiology
- Abstract
Background: Neurologic dysfunction remains an ongoing challenge in the diagnosis of type A aortic dissection (AAD). Our study analyzed the impact of preoperative neurologic dysfunction (PND) on outcome and assessed a potential link between PND and specific patterns of postoperative neurologic injury., Methods: Medical records of 338 patients (70.1% men; mean age, 59.3 ± 13.7 years) undergoing surgical repair for AAD were screened for the presence of PND. Preoperative characteristics, surgical treatment, and hospital and neurologic outcomes were analyzed according to patients with PND (PND+) and without PND (PND-) RESULTS: There were 50 patients (14.8%) admitted with PND. PND+ patients showed significantly higher rates of postoperative neurologic injury (44.4%) than PND- patients (14.3%; P < .001) with a specific pattern of ischemic lesions in accordance with preoperative neurologic status. While PND+ patients suffered mainly from right hemispheric strokes (66.7% vs 32.4% in PND- patients, P = .024), PND- patients more frequently presented with bilateral cerebral ischemia (56.8% vs 13.3% in PND+ patients, P = .004). Multivariable analysis identified presence of PND (odds ratio, 2.977; 95% confidence interval, 1.357-6.545) as an independent predictor for new postoperative neurologic injury. PND was associated with impaired survival (P = .005)., Conclusions: This study identified an association of preoperative neurologic status and specific stroke patterns after surgical repair of AAD. Irrespective of timing of surgery and reperfusion strategies, preoperative neurologic dysfunction is strongly associated with impaired neurologic outcome., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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