Nature of Neurological Complications and Outcome After Surgery for Type A Aortic Dissection - 29/04/24
, Francesco Onorati, MD, PhD c, Sven Peterss, MD d, Joscha Buech, MD d, e, Giovanni Mariscalco, MD, PhD f, Javier Rodriguez Lega, MD g, Angel G. Pinto, MD g, Antonio Fiore, MD, PhD h, Andrea Perrotti, MD, PhD i, Amelié Hérve, MD i, Andreas Rukosujew, MD j, Till Demal, MD k, Lenard Conradi, MD, PhD k, Konrad Wisniewski, MD j, Marek Pol, MD l, Petr Kacer, MD l, Giuseppe Gatti, MD m, Enzo Mazzaro, MD m, Igor Vendramin, MD, PhD n, Daniela Piani, MD n, Mauro Rinaldi, MD o, Luisa Ferrante, MD o, Robert Pruna-Guillen, MD p, Dario Di Perna, MD q, Sebastien Gerelli, MD q, Zein El-Dean, MD d, Francesco Nappi, MD r, Mark Field, MD, PhD s, Manoj Kuduvalli, MD s, Matteo Pettinari, MD t, Alessandra Francica, MD, PhD c, Mikko Jormalainen, MD, PhD b, Angelo M. Dell'Aquila, MD, PhD j, u, Timo Mäkikallio, MD, PhD a, Tatu Juvonen, MD, PhD b, v, Eduard Quintana, MD, PhD pRésumé |
Surgery for type A aortic dissection (TAAD) is frequently complicated by neurologic complications. The prognostic impact of neurologic complications of different nature has been investigated in this study. The subjects of this analysis were 3,902 patients who underwent surgery for acute TAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD). During the index hospitalization, 722 patients (18.5%) experienced stroke/global brain ischemia. Ischemic stroke was detected in 539 patients (13.8%), hemorrhagic stroke in 76 patients (1.9%) and global brain ischemia in 177 patients (4.5%), with a few patients having had findings of more than 1 of these conditions. In-hospital mortality was increased significantly in patients with postoperative ischemic stroke (25.6%, adjusted odds ratio [OR] 2.422, 95% confidence interval [CI] 1.825 to 3.216), hemorrhagic stroke (48.7%, adjusted OR 4.641, 95% CI 2.524 to 8.533), and global brain ischemia (74.0%, adjusted OR 22.275, 95% CI 14.537 to 35.524) compared with patients without neurologic complications (13.5%). Similarly, patients who experienced ischemic stroke (46.3%, adjusted hazard ratio [HR] 1.719, 95% CI 1.434 to 2.059), hemorrhagic stroke (62.8%, adjusted HR 3.236, 95% CI 2.314 to 4.525), and global brain ischemia (83.9%, adjusted HR 12.777, 95% CI 10.325 to 15.810) had significantly higher 5-year mortality than patients without postoperative neurologic complications (27.5%). The negative prognostic effect of neurologic complications on survival vanished about 1 year after surgery. In conclusion, postoperative ischemic stroke, hemorrhagic stroke, and global cerebral ischemia increased early and midterm mortality after surgery for acute TAAD. The magnitude of risk of mortality increased with the severity of the neurologic complications, with postoperative hemorrhagic stroke and global brain ischemia being highly lethal complications.
Le texte complet de cet article est disponible en PDF.Keywords : aortic dissection, global cerebral ischemia, stroke, type A aortic dissection
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| This study was financially supported by the Finnish Foundation for Cardiovascular Research and the Sigrid Juselius Foundation, Helsinki, Finland. The funding organizations did not have any role in the collection, analysis and interpretation of data, in writing the report, and in the decision to submit the article for publication. |
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| Trial registration: ClinicalTrials.gov Identifier: NCT04831073. |
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