Understanding the influence of temporary neurologic dysfunction in the outcomes of aortic surgery

Temporary neurologic dysfunction (ND) is common after aortic surgery. The Valve Academic Research Consortium 3 classifies ND as NeuroARC Type 1 (stroke), Type 2 (covert injury), and Type 3 (transient ischemic attack/delirium without injury). This study applies these definitions to aortic surgery, focusing on Type 3.

A single-center retrospective analysis of adult patients with open thoracic aortic surgery from March 2005 to December 2023 was performed. Primary end points were mortality and major postoperative complications (reoperation for bleeding, respiratory failure, and acute renal failure). Propensity score weighting using overlap weights balanced covariates between Type 3 and no ND groups. Kaplan-Meier curves and Cox regression analyzed mortality. Multivariable logistic regression identified factors associated with Type 3 ND.

Of 2432 patients, 103 (4.2%) had Type 1, 216 (8.9%) Type 3, and 2113 (86.9%) had no ND. Median age was 62 years (range, 52-71 years), 609 (25.0%) were women, and 1839 (75.6%) underwent aneurysm repair. After balancing, major postoperative complication rates were 49.2% versus 27.6% in Type 3 and no ND, respectively (P < .001). There was no difference in 11-year survival (P = .943) and Type 3 was not independently associated with mortality. Variables associated with Type 3: age (OR 1.05, 1.048; P < .001), left ventricular ejection fraction (OR 0.98, 0.984; P = .018), cerebrovascular disease (OR 2.01, 2.011; P = .001), cardiopulmonary bypass time in minutes (OR 1.004, 1.004; P = .002), retrograde cerebral perfusion (OR 4.25, 4.251; P < .001), and major postoperative complications (OR 3.67, P < .001).

Type 3 occurs in about 10% of cases and is associated with in-hospital complications but not mortality. Identified risk factors may aid in prevention.