Factors associated with acute stroke after type A aortic dissection repair: An analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database.
Publication/Presentation Date
6-1-2020
Abstract
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.
Volume
159
Issue
6
First Page
2143
Last Page
2154
ISSN
1097-685X
Published In/Presented At
Ghoreishi, M., Sundt, T. M., Cameron, D. E., Holmes, S. D., Roselli, E. E., Pasrija, C., Gammie, J. S., Patel, H. J., Bavaria, J. E., Svensson, L. G., & Taylor, B. S. (2020). Factors associated with acute stroke after type A aortic dissection repair: An analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database. The Journal of thoracic and cardiovascular surgery, 159(6), 2143–2154.e3. https://doi.org/10.1016/j.jtcvs.2019.06.016
Disciplines
Medicine and Health Sciences
PubMedID
31351776
Department(s)
Department of Surgery
Document Type
Article