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

Abstract

Surgery for type A aortic dissection (TAAD) is frequently complicated by neurological complications. The prognostic impact of neurological complications of different nature has been investigated in this study.The subjects of this analysis were 3902 patients who underwent surgery for acute TAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD).During the index hospitalization, 722 (18.5%) patients suffered 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 one of these conditions. In-hospital mortality was increased significantly among patients with postoperative ischemic stroke (25.6%, adjusted OR 2.422, 95%CI 1.825-3.216), hemorrhagic stroke (48.7%, adjusted OR 4.641, 95%CI 2.524-8.533) and global brain ischemia (74.0%, adjusted OR 22.275, 95%CI 14.537-35.524) compared to patients without neurological complications (13.5%). Similarly, patients who suffered ischemic stroke (46.3%, adjusted HR 1.719, 95%CI 1.434-2.059), hemorrhagic stroke (62.8%, adjusted HR 3.236, 95%CI 2.314-4.525) and global brain ischemia (83.9%, adjusted HR 12.777, 95%CI 10.325-15.810) had significantly higher 5-year mortality compared to patients without postoperative neurological complications (27.5%). The negative prognostic effect of neurological complications on survival vanished about one year after surgery.In conclusion, postoperative ischemic stroke, hemorrhagic stroke, and global cerebral ischemia increased early and mid-term mortality after surgery for acute TAAD. The magnitude of risk of mortality increased with the severity of the neurological complications, with postoperative hemorrhagic stroke and global brain ischemia being highly lethal complications.