Objectives: Despite improvement in operative and cerebral perfusion techniques, cerebral malperfusion
and neurologic injury remain a dreaded complication of acute type A aortic dissection
(AAD). Aim of this study was, to identify predictors for postoperative stroke and
analyze the impact on morbidity, neurologic recovery and mid-term survival.
Methods: Between 2000 and 2017, 303 patients (71.9% male, mean age 58.9 ± 13.6 years) suffering
from AAD underwent surgical repair. Clinical and imaging data were retrospectively
evaluated. Patients were divided into two groups depending on presence of postoperative
stroke.
Results: Postoperative stroke was detected in 15.8% (n = 48). Patients with postoperative stroke showed higher rates of preoperative cardiopulmonary
resuscitation (CPR) (stroke: 18.8% vs. (vs) no stroke: 3.5%, p < 0.001) and malperfusion (stroke: 47.9% vs. no stroke: 22.4%, p < 0.001). Multivariable analysis identified presence of bovine aortic arch (OR 2.33,
95%CI 1.086–4.998, p = 0.030), preoperative CPR (OR 6.483, 95%CI 1.522–27.616, p = 0.011) and preoperative malperfusion (OR 2.536, 95%CI 1.238–5.194, p = 0.011) as independent predictors for postoperative stroke. Postoperative stroke
had clear impact on morbidity and was associated with higher rates of postoperative
complications and a significantly longer hospital stay (stroke: 23 ± 16 days vs. no
stroke: 17 ± 18 days, p = 0.021). Postoperative stroke was not independently associated with in hospital
mortality (adjusted OR 1.382, 95%CI 0.518–3.687, p = 0.518). There was no difference in mid-term survival between patients with and
without stroke.
Conclusion: This study identified independent preoperative predictors for postoperative stroke.
Postoperative stroke is association with tremendous morbidity and postoperative complications.
Despite a trend toward higher hospital mortality, postoperative stroke surprisingly
does not have an impact on mid-term survival.
