Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients

Abstract

Regardless of standardized neuroprotective techniques, treatment of ATAAD remains a high-risk operation. Preoperatively, the presence of a reduced ejection fraction, a malperfusion syndrome or a high body mass index may increase the perioperative risk for an adverse outcome. A dissection 'entry' localized in the aortic arch or the descending aorta may increase the risk for postoperative stroke. Intraoperatively, cannulation of the femoral artery and extension of the LBI time over 45 min should be avoided. Especially in patients with manifest preoperative cerebral and/or end-organ malperfusion, the cannulation modality as well as the entire neuroprotective management should be chosen individually, respecting its limitations.

Modified hypothermic circulatory arrest for emergent repair of acute aortic dissection type a: a single-center experience

“…Therefore, a low postoperative TND rate (9.5%) with no case of PND observed in our series was not unexpected. Previous studies have identified predictors of the negative neurologic outcomes in surgically treated AADA patients as age, history of cerebrovascular adverse events, renal insufficiency, prolonged hypothermic circulatory arrest time (>40 minutes), and CPB time [2,4,12,15,18,19]. However, in the current study, these risk factors were not found to be independent predictors for postoperative neurologic dysfunction.…”

“…According to the published literature, the overall incidence of TND in AADA patients undergoing hypothermic circulatory arrest and selective cerebral perfusion varies between 2.5-16% and PND with a reported incidence of 4-24% [2,12,15-17,19]. The risk of postoperative neurologic dysfunction was reported to be significantly influenced by the site of arterial cannulation and could be greatly reduced by cannulating a graft sewn to the right axillary artery [5,7,15]. All patients in this study were cannulated through an 8-10 mm Gore-Tex graft sewn to the axillary artery and then received ACP.…”

“…Variables with a univariate p <0.2 or those of known clinical importance for 30-day mortality and postoperative outcome events were included in a stepwise multivariate logistic regression model to calculate odds ratios (OR) and its 95% confidence intervals (CI) (Table 2). As others did before [15], we combined re-exploration for bleeding, dialysis-dependent renal failure, postoperative pneumonia, mediastinal infection, sepsis, tracheotomy and TND as the composite postoperative complications to increase the sensitivity for identifying risk factors. All p values less than 0.05 were considered statistically significant.…”

The impact of arterial cannulation strategy on operative outcomes in aortic surgery: Evidence from a comprehensive meta-analysis of comparative studies on 4476 patients

“…After evaluating the full-text articles, 14 were finally selected for the systematic review and meta-analysis. [14][15][16][17][18][19][20][21][22][23][24][25][26][27] An overview of the studies and study quality assessment are summarized in Tables 1 and 2, respectively. An outline of the systematic review process is depicted in Figure 1.…”

“…The CC group included right axillary artery cannulation in 7 studies, [20][21][22][23][24][25][26] direct aortic cannulation in 2 studies, 18,19 both right axillary artery or direct aortic cannulation in 3 studies, [15][16][17] and right axillary artery or innominate artery or direct aortic cannulation in 2 studies. [14][15][16][17][18][19][20][21][22][23][24][25][26][27] A total of 8 of 14 studies reported on type A aortic dissection cases only, [16][17][18][20][21][22][23]25 whereas the others included mixed aortic pathologies. 14,15,19,24,26,27 Cerebral protection strategies included hypothermic circulatory arrest (HCA), antegrade selective cerebral perfusion (ASCP), and retrograde cerebral perfusion.…”