ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2020 April;61(2):220-5

DOI: 10.23736/S0021-9509.19.10710-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Operative strokes after repair of acute type A dissections: predisposing factors and implications

Asher B. WEISBERG ¹ ✉, Hassan NEMEH ², Loay KABBANI ³, Alexander SHEPARD ³, Meredith VAN HARN ⁴, Jeffrey MORGAN ⁵, Jamil BORGI ⁶

¹ Department of General Surgery, Henry Ford Hospital, Detroit, MI, USA; ² Department of Cardiac Surgery, Henry Ford Hospital, Detroit, MI, USA; ³ Department of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA; ⁴ Department of Public Health, Henry Ford Hospital, Detroit, MI, USA; ⁵ Department of Surgery, Baylor College of Medicine, Houston, TX, USA; ⁶ Division of Cardiothoracic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon

BACKGROUND: Type A aortic dissection is a surgical emergency with a high morbidity and mortality. Strokes occur in up to 25% and are among the most feared complications. This study aims to evaluate factors linked to stroke development and the implications of strokes on outcomes.
METHODS: Patients from 2000-2014 were stratified based on the development of stroke. Factors were compared between the groups using chi-square or Fisher’s exact tests for categorical variables, and independent two-group t-tests for continuous variables. Impact on survival at 30 days, 1 and 5 years were evaluated using the life-test method.
RESULTS: Two hundred patients were analyzed. Forty (20%) developed a stroke. Preoperative factors associated with stroke were female gender (34% vs. 14% P=0.01), presentation with shock (32% vs. 17%; P=0.035), and history of stroke (64% vs. 17%; P<0.001). Femoral cannulation was the only technical variable associated with stroke (49% vs. 32%; P=0.035). Stroke patients had a higher rate of pneumonia (41% vs. 11%; P<0.001), respiratory failure (36% vs. 7%; P<0.001), hemodialysis requirement (38% vs. 16%; P=0.015), and longer hospital stay (23.9±17.8 days vs. 16.1±13.5 days; P=0.012). Stroke was associated with a lower survival probability at 30 days (0.73 vs. 0.89), 1 year (0.56 vs. 0.78), and 5 years (0.29 vs. 0.70) (P<0.001).
CONCLUSIONS: Patients who developed stroke after type A dissection repair had higher complication rates and a higher mortality rate at 30 days, 1 year, and 5 years. Femoral cannulation was the only technical factor associated with a higher rate of strokes.

KEY WORDS: Stroke; Dissecting aneurysm; Postoperative period