Stroke after emergent surgery for acute type A aortic dissection: predictors, outcome and neurological recovery†

Dumfarth, Julia; Kofler, Markus; Stastny, Lukas; Plaikner, Michaela; Krapf, Christoph; Semsroth, Severin; Grimm, Michael

doi:10.1093/ejcts/ezx465

Cited by 81 publications

(70 citation statements)

References 21 publications

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“…In Table 1, it summarized observational single center experience focusing on neurological outcomes after TAAAD (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Resultsmentioning

confidence: 99%

“…The latest series available on this topic, investigated the predictors and outcomes of stroke in 303 patients with TAAAD undergoing surgical repair (5). The prevalence of permanent postoperative neurologic injuries was 15.8% and multivariable analysis identified the presence of bovine aortic arch (OR =2.33), preoperative cardiopulmonary resuscitation (OR =6.483) and preoperative malperfusion (OR =2.536) as independent predictors for postoperative stroke.…”

Section: Resultsmentioning

confidence: 99%

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Cerebral perfusion issues in type A aortic dissection

et al. 2018

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Stroke events are very common in acute type A aortic dissection. Cerebral malperfusion could manifest at presentation due to prolonged arch vessels hypoperfusion or develop after surgery for inadequate cerebral protection during arch repair. To reduce this detrimental complication there are several adjuncts that can be adopted for cerebral protection such as direct antegrade or retrograde cerebral perfusion (RCP) and use period of deep to moderate hypothermic circulatory arrest time; however, they are often insufficient as preoperative malperfusion already caused irreversible ischemic damages. The aim of the current review article is to analyze the principal series reporting on neurological injuries during type A aortic dissection to focus on the outcomes according to the type of surgical management and identify possible predictors to better manage this complication.

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“…In Table 1, it summarized observational single center experience focusing on neurological outcomes after TAAAD (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Cerebral perfusion issues in type A aortic dissection

et al. 2018

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“…In this study, patients with stroke or spinal cord injury were excluded because these patients were not suitable for NIV and were susceptible to multiple organ dysfunction, longer ICU LOS, and higher rate of mortality and tracheostomy. 28 In addition, all subjects enrolled were hemodynamically stable. The mean body mass index in the phase 2 group was 26.59 kg/m 2 .…”

Section: Discussionmentioning

confidence: 99%

Effect of Sequential Noninvasive Ventilation on Early Extubation After Acute Type A Aortic Dissection

Hao

Zheng

et al. 2020

Respir Care

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BACKGROUND: Acute type A aortic dissection (aTAAD) is associated with a high incidence of prolonged postoperative invasive mechanical ventilation. We aimed to assess whether sequential noninvasive ventilation (NIV) could facilitate early extubation postoperatively after a spontaneous breathing trial (SBT) failure among aTAAD patients. METHODS: Beginning in December 2016, we transitioned our weaning strategy from repeated SBT until success (phase 1) to extubation concomitant with sequential NIV (phase 2) for subjects who failed their first SBT. The primary outcomes were re-intubation rate, duration of invasive ventilation, and total duration of ventilation. RESULTS: During the study period, 78 subjects with aTAAD failed their first postoperative SBT (38 subjects in phase 1 and 40 subjects in phase 2). Subjects extubated with sequential NIV had shorter median (interquartile range [IQR]) duration of invasive ventilation of 39.5 (30.8-57.8) h vs 89.5 (64-112) h (P < .001) and median (IQR) length of ICU stay of 6 (4.0-7.8) d vs 7.5 (5.8-9.0) d (P 5 .030). There were no significant differences between the 2 phases with regard to rates of re-intubation (7.5% vs 7.89%, P 5 .95), tracheostomy (2.5% vs 5.26%, P 5 .53), and in-hospital mortality (2.5% vs 2.63%, P 5 .97). CONCLUSIONS: Early extubation followed by sequential NIV significantly reduced duration of invasive ventilation and length of ICU stay without increasing re-intubation rate in postoperative subjects with aTAAD who failed their first SBT.

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“…Postoperative stroke often leads to a low quality of life and early mortality [8,9]. As previously described [10,11], we defined AO as stroke or 30-day mortality to increase the sensitivity of risk factors.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary bypass duration is an independent predictor of adverse outcome in surgical repair for acute type A aortic dissection

Zhang

Pan

Dong

et al. 2020

Preprint

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Objective Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires surgical intervention. This study investigated the relationship between cardiopulmonary bypass (CPB) duration and stroke or early death in ATAAD patients receiving total aortic arch replacement with the frozen elephant trunk procedure (TAR with FET). Methods A retrospective cohort study was conducted at the Beijing Anzhen Hospital from December 2014 to June 2016. Patients receiving TAR with FET for ATAAD were included. CPB duration was recorded during the operation. Adverse outcome (AO) was defined as 30-day mortality or stroke. In total, 258 consecutive patients were ultimately analysed. In addition, as the primary outcome, AO was compared using propensity-matched scoring (PS). Results The incidence of AO was 13.6% (n = 35). The 30-day mortality rate was 10.8%, and the stroke rate was 9.3%. Patients were aged 47.9 ± 10.6 years old and were predominantly male (76.0%). The average CPB duration was 224.3 ± 58.7 min. The duration of CPB was an independent predictor of AO occurrence after adjusting for confounding factors through multivariable logistic regression analysis (OR 1.101, 95% CI 1.003–1.208; P = 0.042). After PS matching, 33 matched pairs were created. In the matched analysis, CPB duration remained an AO risk factor (OR 1.178, 95% CI 1.032–1.345; P = 0.015). Conclusions CPB duration is an independent predictor of adverse outcome in surgical repair for ATAAD. The underlying mechanisms of this association are key for the development of improved prevention strategies.

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Stroke after emergent surgery for acute type A aortic dissection: predictors, outcome and neurological recovery†

Abstract: This study identified independent preoperative predictors for postoperative stroke. Although postoperative stroke was associated with significant morbidity and postoperative complications, significant impairment in mid-term survival could not be confirmed by the data.

Cited by 81 publications

References 21 publications

Cerebral perfusion issues in type A aortic dissection

Cerebral perfusion issues in type A aortic dissection

Effect of Sequential Noninvasive Ventilation on Early Extubation After Acute Type A Aortic Dissection

Cardiopulmonary bypass duration is an independent predictor of adverse outcome in surgical repair for acute type A aortic dissection

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