Computed Tomography Scan Predicts Abdominal Interventions but Not Stroke after Surgery for Acute Type A Aortic Dissection

Background We hypothesized that preoperative computed tomography (CT) is a predictor of abdominal intervention for visceral malperfusion and stroke after emergent surgery for acute type A aortic dissection (AAAD). Methods A total of 90 patients, mean (+/- SD [standard deviation]) age 62 (+/- 12) years, 76% males, undergoing emergent surgery for AAAD at our institution from May 2008 to August 2013 were included. All clinical data were collected prospectively and correlated to CT images. Results At initial presentation 9 (10%) patients showed preoperative focal neurologic deficit or coma, 10 patients (11%) complained of abdominal pain, and the logistic EuroSCORE was 44 (+/- 22). Hemiarch replacement was performed in 96%, total arch in 4%. The duration of hypothermic circulatory arrest (HCA) at 28 degrees C bladder temperature was 26 (+/- 19) minutes. Cross-clamp time was 88 (+/- 39) minutes, and cardiopulmonary bypass (CPB) time 148 (+/- 49) minutes. Overall 30-day mortality was 13%. Moreover, 12 (13%) patients required postoperative abdominal interventions for suspected visceral malperfusion; stroke occurred in 25 (28%) patients. Logistic regression revealed that "dissection of the celiac trunk and/or the superiormesenteric artery" in preoperative CT images is a predictor of postoperative abdominal interventions for visceral malperfusion (p = 0.03), but preoperative abdominal pain is not similarly predictive. Postoperative stroke is best predicted by preoperative neurologic symptoms (p = 0.01), but not by supra-aortic vessel dissection in preoperative CT images. Conclusion In patients undergoing surgery for AAAD, analysis of preoperative CT images allows identifying those with a high risk of postoperative abdominal intervention for visceral malperfusion. Postoperative stroke is best predicted by preoperative neurologic symptoms.