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Factors Associated With Acute Stroke After Type A Aortic Dissection Repair: An Analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database

Monday, June 24, 2019

Submitted by

Wei-Guo Ma

Source

Source Name: The Journal of Thoracic and Cardiovascular Surgery

Source URL: https://doi.org/10.1016/j.jtcvs.2019.06.016

Author(s)

Mehrdad Ghoreishi, Thoralf M. Sundt, Duke E. Cameron, Sari D. Holmes, Eric E. Roselli, Chetan Pasrija, James S. Gammie, Himanchu J. Patel, Joseph Bavaria, Lars G. Svensson, Bradley S. Taylor

Colleagues from five heart centers performed a study on the incidence and factors associated with acute stroke following type A repair using the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD).

Among 7353 Acute type A repair performed at 772 centers between 2014 to 2017, operative mortality was 17% and incidence of postoperative stroke was 13%. Multivariate analysis showed that patients with axillary cannulation versus femoral (OR=0.60, P<0.001) and retrograde cerebral perfusion versus no cerebral perfusion (OR=0.75, P=0.008) or antegrade cerebral perfusion (OR=0.75, P=0.007) were less likely to develop acute stroke, while total arch replacement versus hemi-arch technique (OR=1.30, P=0.013) was predictive of higher risk for stroke. Longer times of circulatory arrest, cerebral perfusion and cardiopulmonary bypass were all related to higher risk of postoperative stroke. The degree of hypothermia and center volume were not related to stroke incidence.