Analysis of Risk Factors of Postoperative Neurological Complications in Patients with Stanford Type A Aortic Dissection Undergoing Sun’s Procedure

Abstract

Objective: This study analyzed the risk factors of neurological complications in patients with Stanford type A aortic dissection after Sun’s procedure in a single-center with the purpose of improving the effects. Methods: From January 2019 to December 2020, the clinical data of 480 patients with Stanford type A aortic dissection, who were treated by Sun’s procedure in our center were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the risk factors of postoperative neurological complications. According to whether there were neurological complications after surgery, they were divided into two groups: the group with complications (n=70) and the group without complications (n=410). The clinical data of the two groups were collected and compared. Results: There were 70 cases of patients with postoperative neurological complications in 480 cases. The incidence rates of temporary neurological dysfunction (TND) and permanent neurological dysfunction (PND) was 11.5% (55/480) and 3.1% (15/480), respectively. Univariate analysis showed that the age (? 70 years), stroke history, femoral artery intubation and cardiopulmonary bypass (CPB) time were associated with postoperative PND (p < 0.05). Renal dysfunction, emergency surgery, postoperative hypernatremia, postoperative hyperglycemia, postoperative hypoxemia, postoperative low cardiac output syndrome, and assisted time of suction influenced the occurrence of postoperative TND (p < 0.05). Multivariate logistic regression analysis showed that age (? 70 years), stroke history, femoral artery intubation and CPB time were independent risk factors for PND. Renal dysfunction, emergency surgery, postoperative hypernatremia, postoperative hyperglycemia, postoperative hypoxemia, postoperative low cardiac output syndrome, and aspiration time were independent risk factors for TND. Compared with the two groups, the hospitalization time and ICU time of the patients in the neurological complications group were significantly prolonged, and the mortality rate was significantly increased (p < 0.05). Conclusion: There are many risk factors for neurological complications in patients with Stanford type A aortic dissection after surgery. With the improvement of surgical techniques, optimization of cerebral perfusion, and interventions for risk factors, Sun’s procedure remains the preferred treatment for Stanford type A aortic dissection.

Intravenous Tranexamic Acid Reduces Post-Operative Bleeding and Blood Transfusion in Patients Undergoing Aortic Surgery: A PRISMA-Compliant Systematic Review and Meta-Analysis

“…However, in the rate of reoperation for bleeding and postoperative transfusion of RBC, TXA group showed significantly less rate compared to placebo. Casati et al [6], Xu et al [10] and Zhang et al [11] demonstrated similar results in their respective studies comparing the groups. Decreasing operative bleeding would lessen the risks and costs related to blood transfusion.…”

“…1 illustrates how database searches identified seven articles for full evaluation. There were four studies eligible for inclusion in the meta-analysis [ 6 , 8 , 10 , 11 ]. Table 1 (Ref.…”

“…Table 1 (Ref. [ 6 , 8 , 10 , 11 ]) presents a description of these articles. Of the 4 references, two [ 6 , 8 ] were written in English (2 from Italy), and the other two [ 10 , 11 ] were in Chinese.…”

“…As showed in Table 1 , among the four trials, three included patients undergoing thoracic aortic aneurysm surgery [ 6 , 10 , 11 ], one included patients with surgery of abdominal aortic aneurysm [ 8 ]. There were 273 patients enrolled in the 4 eligible trials, and 139 were allocated to the TXA group and 134 to the Control (placebo) group.…”

“…At present, TXA is a frequently-used antifibrinolytic agent in cardiac and non-cardiac surgeries. Although tranexamic acid had a significant effect on reduction of bleeding in previous researches, its role in aortic surgery was rarely studied [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. The efficacy of TXA in aortic surgical patients remains unknown.…”