Outcomes following repair of acute type A aortic dissection in patients with cerebral malperfusion

Patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion have significantly poorer postoperative outcomes, making the decision whether to perform acute surgery difficult. The aim of this study was to investigate types of neurological symptoms and radiological findings and their association with permanent neurological injury and mortality following ATAAD repair.

This was a single-center, retrospective, observational study. A total of 629 patients underwent ATAAD surgery between January 1998 and December 2023 at Skåne University Hospital, Lund, Sweden. Of these, 93 (14.7%) presented with cerebral malperfusion and constituted the study population. The primary endpoints were clinical neurological injury and 30-day mortality.

Overall 30-day mortality was 25.0%. Fifty-two patients (57.1%) had persisting neurological deficit. Patients with postoperative neurological deficit had significantly higher 30-day mortality than patients without postoperative neurological deficit (37.3% vs 5.1%, p > 0.001). Common carotid artery dissection and carotid artery occlusion were significantly more frequent in patients who developed postoperative neurological injury. Preoperative hemiparesis/hemiplegia was associated with a significant increase of persisting neurological deficits, and unconsciousness was associated with a significant increase in 30-day mortality or persisting neurological deficits. After repair, 52.2% of patients showed an improvement in their clinical neurological status.

In ATAAD patients who present with cerebral malperfusion, the risk of permanent neurological deficit and 30-day mortality is high, but a significant proportion of patients survive and more than half demonstrate an improved neurological state postoperatively.