Factors associated with acute stroke after type A aortic dissection repair: An analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database

被引:112
作者
Ghoreishi, Mehrdad [1 ]
Sundt, Thoralf M. [2 ]
Cameron, Duke E. [2 ]
Holmes, Sari D. [1 ]
Roselli, Eric E. [3 ]
Pasrija, Chetan [1 ]
Gammie, James S. [1 ]
Patel, Himanshu J. [4 ]
Bavaria, Joseph E. [5 ]
Svensson, Lars G. [3 ]
Taylor, Bradley S. [1 ]
机构
[1] Univ Maryland, Div Cardiac Surg, Sch Med, 110 S Paca St, Baltimore, MD 21224 USA
[2] Massachusetts Gen Hosp, Div Cardiac Surg, Boston, MA 02114 USA
[3] Cleveland Clin, Heart & Vasc Inst, Cleveland, OH 44106 USA
[4] Univ Michigan, Cardiovasc Ctr, Ann Arbor, MI 48109 USA
[5] Hosp Univ Penn, Div Cardiovasc Surg, 3400 Spruce St, Philadelphia, PA 19104 USA
关键词
aorta; dissection; stroke; RETROGRADE CEREBRAL PERFUSION; HYPOTHERMIC CIRCULATORY ARREST; ELEPHANT TRUNK REPAIR; DEEP HYPOTHERMIA; ARCH REPLACEMENT; FEMORAL CANNULATION; ANTEGRADE; OUTCOMES; IMPACT; METAANALYSIS;
D O I
10.1016/j.jtcvs.2019.06.016
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: Data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to examine the incidence and factors associated with acute stroke following type A repair. Methods: Acute type A aortic dissection repairs performed from 2014 to 2017 were identified from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The effect of cannulation strategy (eg, axillary, femoral, direct, or innominate), lowest temperature, cerebral protection techniques (antegrade cerebral profusion, retrograde cerebral perfusion, both, or none), repair technique, and institutional volume on postoperative stroke was investigated. Results: Acute type A repair was performed on 8937 patients at 772 centers, of which 7353 met inclusion criteria. Operative mortality was 17% and incidence of postoperative stroke was 13%. Axillary cannulation was associated with lower risk of stroke versus femoral (odds ratio, 0.60; P<.001). Retrograde cerebral perfusion was associated with reduced risk for stroke compared with no cerebral perfusion (odds ratio, 0.75; P=.008) or antegrade cerebral perfusion (odds ratio, 0.75; P=.007). Total arch replacement was associated with greater risk for stroke versus hemiarch technique (odds ratio, 1.30; P=.013). Longer circulatory arrest time, cerebral perfusion time, and cardiopulmonary bypass time were all related to higher risk of postoperative stroke. Conclusions: Stroke is a common complication after type A repair. Axillary cannulation was associated with lower incidence of stroke, whereas femoral cannulation significantly increased the risk of stroke regardless of the cerebral perfusion strategy or the degree of hypothermia. Retrograde cerebral profusion was found to have reduced risk for postoperative stroke. Degree of hypothermia and center volume were not related to stroke incidence.
引用
收藏
页码:2143 / +
页数:15
相关论文
共 32 条
[1]   RETROGRADE CEREBRAL AND DISTAL AORTIC PERFUSION DURING ASCENDING AND THORACOABDOMINAL AORTIC OPERATIONS [J].
BAVARIA, JE ;
WOO, YJ ;
HALL, RA ;
CARPENTER, JP ;
GARDNER, TJ .
ANNALS OF THORACIC SURGERY, 1995, 60 (02) :345-353
[2]   The impact of arterial cannulation strategy on operative outcomes in aortic surgery: Evidence from a comprehensive meta-analysis of comparative studies on 4476 patients [J].
Benedetto, Umberto ;
Raja, Shahzad G. ;
Amrani, Mohamed ;
Pepper, John R. ;
Zeinah, Mohamed ;
Tonelli, Euclide ;
Biondi-Zoccai, Giuseppe ;
Frati, Giacomo .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2014, 148 (06) :2936-U1628
[3]   National Outcomes in Acute Aortic Dissection: Influence of Surgeon and Institutional Volume on Operative Mortality [J].
Chikwe, Joanna ;
Cavallaro, Paul ;
Itagaki, Shinobu ;
Seigerman, Matthew ;
DiLuozzo, Gabrielle ;
Adams, David H. .
ANNALS OF THORACIC SURGERY, 2013, 95 (05) :1563-1569
[4]   Acute Type A Dissection: Impact of Antegrade Cerebral Perfusion Under Moderate Hypothermia [J].
Comas, George M. ;
Leshnower, Bradley G. ;
Halkos, Michael E. ;
Thourani, Vinod H. ;
Puskas, John D. ;
Guyton, Robert A. ;
Kilgo, Patrick D. ;
Chen, Edward P. .
ANNALS OF THORACIC SURGERY, 2013, 96 (06) :2135-2141
[5]   Simplifying aortic arch surgery: open zone 2 arch with single branched thoracic endovascular aortic repair completion [J].
Desai, Nimesh D. ;
Hoedt, Ashley ;
Wang, Grace ;
Szeto, Wilson Y. ;
Vallabhajosyula, Prasthanth ;
Reinke, Mary ;
Bavaria, Joseph E. .
ANNALS OF CARDIOTHORACIC SURGERY, 2018, 7 (03) :351-356
[6]   Stroke after emergent surgery for acute type A aortic dissection: predictors, outcome and neurological recovery [J].
Dumfarth, Julia ;
Kofler, Markus ;
Stastny, Lukas ;
Plaikner, Michaela ;
Krapf, Christoph ;
Semsroth, Severin ;
Grimm, Andmichael .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2018, 53 (05) :1013-1020
[7]   Retrograde cerebral perfusion provides negligible flow through brain capillaries in the pig [J].
Ehrlich, MR ;
Hagl, C ;
McCullough, JN ;
Zhang, N ;
Shiang, H ;
Bodian, C ;
Griepp, RB .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2001, 122 (02) :331-338
[8]   Axillary cannulation significantly improves survival and neurologic outcome after atherosclerotic aneurysm repair of the aortic root and ascending aorta [J].
Etz, Christian D. ;
Plestis, Konstadinos A. ;
Kari, Fabian A. ;
Silovitz, Daniel ;
Bodian, Carol A. ;
Spielvogel, David ;
Griepp, Randall B. .
ANNALS OF THORACIC SURGERY, 2008, 86 (02) :441-447
[9]   Impact of Perfusion Strategy on Outcome After Repair for Acute Type A Aortic Dissection [J].
Etz, Christian D. ;
von Aspern, Konstantin ;
da Rocha e Silva, Jaqueline ;
Girrbach, Felix F. ;
Leontyev, Sergey ;
Luehr, Maximilian ;
Misfeld, Martin ;
Borger, Michael A. ;
Mohr, Friedrich W. .
ANNALS OF THORACIC SURGERY, 2014, 97 (01) :78-86
[10]   Femoral cannulation is safe for type A dissection repair [J].
Fusco, DS ;
Shaw, RK ;
Tranquilli, M ;
Kopf, GS ;
Elefteriades, JA .
ANNALS OF THORACIC SURGERY, 2004, 78 (04) :1285-1289