Nature of Neurological Complications and Outcome After Surgery for Type A Aortic Dissection

被引：3

作者：

Biancari, Fausto ^{[1
,2
]}

Onorati, Francesco ^{[3
]}

Peterss, Sven ^{[4
]}

Buech, Joscha ^{[4
,5
]}

Mariscalco, Giovanni ^{[6
]}

Lega, Javier Rodriguez ^{[7
]}

Pinto, Angel G. ^{[7
]}

Fiore, Antonio ^{[8
]}

Perrotti, Andrea ^{[9
]}

Herve, Amelie ^{[9
]}

Rukosujew, Andreas ^{[10
]}

Demal, Till ^{[11
]}

Conradi, Lenard ^{[11
]}

Wisniewski, Konrad ^{[10
]}

Pol, Marek ^{[12
,13
]}

Kacer, Petr ^{[12
,13
]}

Gatti, Giuseppe ^{[14
]}

Mazzaro, Enzo ^{[14
]}

Vendramin, Igor ^{[15
]}

Piani, Daniela ^{[15
]}

Rinaldi, Mauro ^{[16
]}

Ferrante, Luisa ^{[16
]}

Pruna-Guillen, Robert ^{[17
]}

Di Perna, Dario ^{[18
]}

Gerelli, Sebastien ^{[18
]}

El-Dean, Zein ^{[4
]}

Nappi, Francesco ^{[19
]}

Field, Mark ^{[20
]}

Kuduvalli, Manoj ^{[20
]}

Pettinari, Matteo ^{[21
]}

Francica, Alessandra ^{[3
]}

Jormalainen, Mikko ^{[2
]}

Dell'Aquila, Angelo M. ^{[10
,22
]}

Makikallio, Timo ^{[1
]}

Juvonen, Tatu ^{[2
,23
]}

Quintana, Eduard ^{[17
]}

机构：

[1] Univ Helsinki, South Karel Cent Hosp, Dept Med, Lappeenranta, Finland

[2] Univ Helsinki, Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland

[3] Univ Verona, Med Sch, Div Cardiac Surg, Verona, Italy

[4] Ludwig Maximilians Univ Munchen, LMU Univ Hosp, Munich, Germany

[5] German Ctr Cardiovasc Res, Partner Site Munich Heart Alliance, Munich, Germany

[6] Glenfield Hosp, Dept Cardiac Surg, Leicester, England

[7] Univ Hosp Gregorio Maranon, Cardiovasc Surg Dept, Madrid, Spain

[8] Hop Univ Henri Mondor, Assistance Publ Hop Paris, Dept Cardiac Surg, Creteil, France

[9] Univ FrancheComte, Dept Thorac & Cardiovasc Surg, Besancon, France

[10] Univ Hosp Muenster, Dept Cardiothorac Surg, Munster, Germany

[11] Univ Heart & Vasc Ctr Hamburg, Dept Cardiovasc Surg, Hamburg, Germany

[12] Charles Univ Prague, Fac Med 3, Dept Cardiac Surg, Prague, Czech Republic

[13] Univ Hosp Kralovske Vinohrady, Prague, Czech Republic

[14] Azienda Sanit Univ Giuliano Isontina, Cardiothorac & Vasc Dept, Div Cardiac Surg, Trieste, Italy

[15] Azienda Sanit Univ Friuli Cent, Cardiothorac Dept, Udine, Italy

[16] Univ Turin, Molinette Hosp, Cardiac Surg, Turin, Italy

[17] Univ Barcelona, Hosp Clin Barcelona, Dept Cardiovasc Surg, Barcelona, Spain

[18] Ctr Hosp Annecy Genevois, Dept Cardiac Surg, Epagny Metz Tessy, France

[19] Ctr Cardiol Nord St Denis, Dept Cardiac Surg, Paris, France

[20] Liverpool Heart & Chest Hosp, Liverpool Ctr Cardiovasc Sci, Liverpool, England

[21] Ziekenhuis Oost Limburg, Dept Cardiac Surg, Genk, Belgium

[22] Martin Luther Univ Halle Wittenberg, Dept Cardiac Surg, Halle, Germany

[23] Univ Oulu, Res Unit Surg Anesthes & Crit Care, Oulu, Finland

来源：

AMERICAN JOURNAL OF CARDIOLOGY | 2024年 / 219卷

关键词：

aortic dissection; global cerebral ischemia; stroke; type A aortic dissection; REGISTRY;

D O I：

10.1016/j.amjcard.2024.03.001

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Surgery for type A aortic dissection (TAAD) is frequently complicated by neurologic complications. The prognostic impact of neurologic complications of different nature has been investigated in this study. The subjects of this analysis were 3,902 patients who underwent surgery for acute TAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD). During the index hospitalization, 722 patients (18.5%) experienced stroke/global brain ischemia. Ischemic stroke was detected in 539 patients (13.8%), hemorrhagic stroke in 76 patients (1.9%) and global brain ischemia in 177 patients (4.5%), with a few patients having had findings of more than 1 of these conditions. In-hospital mortality was increased significantly in patients with postoperative ischemic stroke (25.6%, adjusted odds ratio [OR] 2.422, 95% confidence interval [CI] 1.825 to 3.216), hemorrhagic stroke (48.7%, adjusted OR 4.641, 95% CI 2.524 to 8.533), and global brain ischemia (74.0%, adjusted OR 22.275, 95% CI 14.537 to 35.524) compared with patients without neurologic complications (13.5%). Similarly, patients who experienced ischemic stroke (46.3%, adjusted hazard ratio [HR] 1.719, 95% CI 1.434 to 2.059), hemorrhagic stroke (62.8%, adjusted HR 3.236, 95% CI 2.314 to 4.525), and global brain ischemia (83.9%, adjusted HR 12.777, 95% CI 10.325 to 15.810) had significantly higher 5-year mortality than patients without postoperative neurologic complications (27.5%). The negative prognostic effect of neurologic complications on survival vanished about 1 year after surgery. In conclusion, postoperative ischemic stroke, hemorrhagic stroke, and global cerebral ischemia increased early and midterm mortality after surgery for acute TAAD. The magnitude of risk of mortality increased with the severity of the neurologic complications, with postoperative hemorrhagic stroke and global brain ischemia being highly lethal complications. (c) 2024 Elsevier Inc. All rights reserved. (Am J Cardiol 2024;219:85 - 91)

引用

页码：85 / 91

页数：7

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