Original article: cardiovascular
Emergency operation for acute type A aortic dissection: neurologic complications and early mortality

https://doi.org/10.1016/S0003-4975(00)01824-5Get rights and content

Abstract

Background. Acute type A aortic dissection is a surgical emergency still associated with high postoperative complications. The aim of this study was to investigate factors for hospital mortality and neurologic deficit in patients undergoing emergency operation for acute type A aortic dissection.

Methods. Eighty-five consecutive patients (age range, 20 to 82 years) operated on for acute type A aortic dissection over a 6-year period were evaluated. Univariate and stepwise multiple logistic regression analyses were conducted among 32 perioperative variables.

Results. All patients underwent surgical procedures under deep hypothermic circulatory arrest. Antegrade or retrograde cerebral perfusion was used in 23 patients (27.1%) and 18 patients (21.2%), respectively. Forty-three patients underwent arch/hemiarch replacement and the ascending aorta was replaced in 42 patients. Overall mortality rate was 25.9% (22 of 85 patients). Multiple logistic regression analysis showed that lack of cerebral perfusion (p = 0.021) and postoperative renal failure (p = 0.006) were the best predictors for hospital death. Twenty-one patients (24.7%) experienced neurologic accidents. The risk factor for postoperative neurologic complication was lack of cerebral perfusion (p = 0.013). Hospital mortality was 13% (3 of 23 patients) and 16.7% (3 of 18 patients) in the antegrade and retrograde cerebral perfusion groups (p > 0.05) and neurologic deficit was 13% (3 of 23 patients) and 11.1% (2 of 18 patients), respectively (p > 0.05).

Conclusions. Hospital mortality and neurologic complications in patients undergoing emergent operation for acute type A aortic dissection were reduced when cerebral perfusion was used with deep hypothermic circulatory arrest.

Section snippets

Patients

Between April 1992 and May 1998, 85 consecutive patients were operated on for acute type A aortic dissection at the Institute of Cardiac Surgery, University of Rome “La Sapienza.”

Preoperative clinical symptoms, which included precordial pain, back pain, or abdominal pain, were present in all patients. Mean time between symptoms onset and operation was 22.9 ± 15.6 hours (range, 6 to 43 hours). Complications at hospital admission and incremental risk factors for death and neurologic deficit are

Results

Mean age of the study population was 60.1 ± 11.6 years (range, 20 to 82 years). Sixty-four patients (75.3%) were men and 21 (24.7%) were women. Operative data and postoperative complications are listed in Table 1. Mean bypass time was 202.2 ± 64.2 minutes (range, 105 to 410 minutes). Mean circulatory arrest time was 59.9 ± 36.9 minutes (range, 15 to 174 minutes).

One patient that had undergone a previous Bentall’s operation for acute type A aortic dissection presented in hemodynamic shock for

Comment

This study identified, in a large series of patients, factors for hospital mortality and neurologic complications after emergent operation for acute type A aortic dissection. The main goals of surgical treatment of patients with an acute type A are to prevent aortic rupture, reverse organ ischemia, and correct aortic valve pathology, but the operation must be performed before these complications occur or their effect become irreversible.

Despite the recent advances in circulatory and

Acknowledgements

We thank Professor Sir Magdi Yacoub for his kind review of our manuscript.

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