Multivariate analysis of predictors of late stroke after total aortic arch repair

Abstract

Objective: The number of aortic surgeries has recently increased, with improvement of outcome due to the development of various novel operative techniques and adjuncts. Although the postoperative incidence of stroke, the most severe complication of aortic surgery, is still a matter of concern and has been described well previously, late stroke after aortic arch repair has not been described well. We assessed the incidence and predictors of late stroke after total aortic arch repair. Methods: From January 1993 to December 2003, 470 patients underwent total aortic arch repair in our institution. All patients, whether undergoing elective, urgent, or emergent aortic arch repair, were included. Emergent operation was required for 115 patients because of rupture or acute type A dissection. For brain protection, retrograde cerebral perfusion was used in 27% (125) and selective cerebral perfusion in 75% (353) of cases. The follow-up period was 32.5G31.5 months. Late stroke was defined as stroke occurring more than 30 days postoperatively. Results: The incidence of early postoperative stroke was 4.9% (23/470), while that of late postoperative stroke was 6.0% (28/470). On univariate analysis, postoperative atrial fibrillation (PZ0.014), preoperative prevalence of craniocervical lesions (PZ0.0001), and advanced age (PZ0.046) were each significantly related to late stroke. A Cox proportional hazards model detected postoperative atrial fibrillation (PZ0.013, ORZ3.02, 95% CI: 1.26-7.24) and preoperative prevalence of craniocervical lesions (PZ0.0001, ORZ5.37, 95% CI: 2.30-12.52) as predictors of late stroke. Conclusions: Postoperative atrial fibrillation and preoperative prevalence of craniocervical lesions were found to be risk factors for late stroke after total aortic arch repair.

Dexmedetomidine sedation during the nighttime reduced the incidence of postoperative atrial fibrillation in cardiovascular surgery patients after tracheal extubation

“…AF was reported to occur in almost 50 % of patients after major cardiovascular surgeries such as total arch replacement and was higher in these patients than in those with other cardiovascular surgeries such as valve replacement and CABG [ 20 , 21 ]. It was also reported that the occurrence of AF after such major surgeries peaked on day 2, and about half was widely distributed as well after day 3 [ 22 ].…”

Severe systemic inflammatory response syndrome in patients following Total aortic arch replacement with deep hypothermic circulatory arrest

“…No further analysis of neurological defects following TAR, such as stroke or paraplegia until hospital discharge, was carried out in this cohort study owning to their lower incidence (2.1, 3.4%, respectively). Previous investigations provided robust evidence that stroke primarily occurred in patients with concomitant coronary artery bypass grafting, cerebrovascular defect history, or new-set atrial fibrillation [34, 35]. Surgical techniques, including hypothermic circulatory arrest times, selective antegrade cerebral temperature [36, 37], unilateral or bilateral cerebral perfusion [38] and treatment for distal aortic arch aneurysm [19], also significantly contribute to stroke development.…”