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Postoperative stroke in acute type A aortic dissection: incidence, outcomes, and perioperative risk factors

Kasana Raksamani1, Manisa Tangvipattanapong1, Napat Charoenpithakwong1

  • 1Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.

BMC Surgery
|July 25, 2024
PubMed

Insights

Stroke after acute type A aortic dissection (ATAAD) repair is common and increases hospital stays. Key risks include frailty, hypotension, and reduced cerebral oxygen saturation, highlighting the need for targeted interventions.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Anesthesiology

Background:

  • Stroke incidence post-acute type A aortic dissection (ATAAD) repair remains high, leading to adverse outcomes.
  • Managing ATAAD involves complex perioperative care, with a need to address modifiable patient factors and anesthetic strategies.

Purpose of the Study:

  • To determine the incidence and consequences of stroke after ATAAD surgery.
  • To identify perioperative risk factors for stroke in ATAAD patients.

Main Methods:

  • Multicenter retrospective analysis of 516 ATAAD surgery patients.
  • Evaluation of demographic, clinical, surgical, and outcome data.
  • Primary endpoint: postoperative stroke incidence; Secondary endpoints: mortality and complications.

Main Results:

  • Postoperative stroke occurred in 13.6% of patients, significantly extending ICU and hospital stays.
  • Independent stroke risk factors identified: high modified Frailty Index (mFI) (≥4), common carotid artery malperfusion, pre-CPB hypotension, intraoperative cerebral rSO2 decrease (≥20%), and elevated post-CPB vasoactive-inotropic score (VIS) (≥10).

Conclusions:

  • Postoperative stroke substantially prolongs ICU and hospital stays in ATAAD patients.
  • Mitigating risks like high mFI, malperfusion, hypotension, cerebral desaturation, and high VIS is crucial for improving outcomes and reducing stroke prevalence.
Abstract

Keywords:
Acute type a aortic dissectionPostoperative strokeSurgical risk factors

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