Risk factors for cerebral complications after type A aortic dissection surgery: single center's experience

The objective of this study was to retrospectively review the rate and risk factors of cerebral complications (CC) after type A aortic dissection (TAAD) surgery.

A total of 746 TAAD patients who underwent hypothermic circulatory arrest (HCA) surgery were enrolled. Postoperative CC were defined as intracranial hemorrhage or ischemic infarct stroke as confirmed by cranial CT scan. Multivariable logistic regression analysis was used to investigate the risk factors for CC and mortality. To identify the risk role of arch repair methods and flow rate in antegrade cerebral perfusion (ACP), propensity-score matching studies were performed (conservative vs. total arch replacement, n=135; low vs. normal flow rate, n=148).

Thirty-five patients developed CC (6 with intracranial hemorrhage and 29 with ischemic stroke). Thirty-day mortality (34.3%) among patients with CC was significantly higher than that among patients without CC (12.2%). Multivariable logistic regression analysis identified preoperative cerebral ischemia, limb ischemia, end-stage renal disease, and salvage surgery as risk factors for postoperative CC. CAR (P=0.044; odds ratio, 4.587; 95% CI: 1.045-20.130) and low flow rate ACP (P=0.046; odds ratio, 2.139; 95% CI: 1.014-4.515) had protective roles. In the propensity-score matching studies, the CAR group (0.7% and 9.6%, P=0.005 and 0.175, respectively) and the low flow rate ACP group had lower rates of mortality (8.8% and 5.4%, P=0.067 and 0.012, respectively) and CC.

CC are common and lethal after TAAD surgery. Low-flow ACP could be a safer and suitable antegrade perfusion method for cerebral protection.