Immediate Surgery in Acute Type A Dissection and Neurologic Dysfunction: Fighting the Inevitable?

Autor: Christoph Krapf, Severin Semsroth, Simone Gasser, Nikolaos Bonaros, Julia Dumfarth, Lukas Stastny, Thomas Schachner, Michael Grimm, Michaela Plaikner, Markus Kofler
Rok vydání: 2019
Předmět:
Male
Computed Tomography Angiography
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Brain Ischemia
0302 clinical medicine
Postoperative Complications
Risk Factors
Medicine
Coma
Stroke
reproductive and urinary physiology
Aortic dissection
Medical record
Middle Aged
female genital diseases and pregnancy complications
Aortic Aneurysm
Dissection
Carotid Arteries
Acute type
Cerebrovascular Circulation
Hypertension
Consciousness Disorders
Female
Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine
Adult
endocrine system
medicine.medical_specialty
Aortography
Diabetes Complications
03 medical and health sciences
mental disorders
Preoperative Care
Humans
Propensity Score
Aged
Retrospective Studies
Surgical repair
business.industry
Neurological status
Hemodynamics
Length of Stay
medicine.disease
Surgery
Neurologic injury
Aortic Dissection
030228 respiratory system
business
Zdroj: The Annals of thoracic surgery. 110(1)
ISSN: 1552-6259
Popis: 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.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).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.
Databáze: OpenAIRE
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