Factors Associated with Newly Developed Postoperative Neurological Complications in Patients with Emergency Surgery for Acute Type A Aortic Dissection

Mircea Robu; Irina Maria Margarint; Cornel Robu; Andreea Hanganu; Bogdan Radulescu; Ovidiu Stiru; Andrei Iosifescu; Silvia Preda; Mihai Cacoveanu; Cristian Voica; Vlad Anton Iliescu; Horațiu Moldovan

doi:10.3390/medicina60010027

Factors Associated with Newly Developed Postoperative Neurological Complications in Patients with Emergency Surgery for Acute Type A Aortic Dissection

Medicina (Kaunas). 2023 Dec 23;60(1):27. doi: 10.3390/medicina60010027.

Authors

Mircea Robu^{1

2}, Irina Maria Margarint^{1

3}, Cornel Robu^{1

2}, Andreea Hanganu^{1

4}, Bogdan Radulescu^{1

2}, Ovidiu Stiru^{1

2}, Andrei Iosifescu^{1

2}, Silvia Preda^{1

5}, Mihai Cacoveanu^{1

5}, Cristian Voica^{1

5}, Vlad Anton Iliescu^{1

2}, Horațiu Moldovan^{1

5

6}

Affiliations

¹ Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
² Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania.
³ Department of Cardiac Surgery, Emergency Clinical Hospital for Children "Maria Skłodowska Curie", 077120 Bucharest, Romania.
⁴ Neurology Department, Fundeni Clinical Institute, 022322 Bucharest, Romania.
⁵ Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania.
⁶ Academy of Romanian Scientists, 050045 Bucharest, Romania.

Abstract

Background and Objectives: Postoperative neurological complications (NCs) are an important cause of mortality in patients with acute type A aortic dissection (ATAAD). The aim of the study was to determine the association between intraoperative risk factors and newly developed postoperative NCs in patients after emergency surgery for ATAAD. Materials and Methods: A total of 203 patients requiring emergency surgery were included in the study. Patients with preoperative neurological dysfunction, deceased on the operating table or within the first 48 h after intensive care admission, with uncertain postoperative neurologic status or with incomplete records were excluded. Results: Mean age was 57.61 ± 12.27 years. Hyperlipidemia was the most frequent comorbidity (69%). A bicuspid aortic valve was present in 12.8% of cases, severe acute aortic regurgitation was present in 29.1% of patients, and cardiac tamponade was present in 27.1% of cases. The innominate artery was the most frequently dissected supra-aortic artery in 27.1% of cases. In 65% of cases, the primary entry tear was at the level of the ascending aorta. The incidence of newly developed postoperative NCs was 39.4%. The most common surgical technique performed was supra-coronary ascending aorta and hemiarch replacement, in 53.2% of patients. Using logistic regression, cardiopulmonary bypass time (OR = 1.01; 95% CI = 1.01-1.02; p < 0.001), aortic cross-clamp time over 3 h (OR = 2.71, 95% CI = 1.43-5.14, p = 0.002) and cerebral perfusion time (OR = 1.02; 95% CI = 1.002-1.03; p = 0.027) were independently associated with newly developed postoperative NCs. Conclusions: Based on the results of the study, all efforts should be made to reduce operative times. Using a simple surgical technique, like the supra-coronary ascending aorta and hemiarch technique, whenever possible, and using a simpler technique for cerebral perfusion like unilateral cerebral perfusion via the right axillary artery, could reduce operating times.

Keywords: brain; delirium; dissection; hypoxia-ischemia; ischemic stroke; spinal cord ischemia; thoracic aorta.

MeSH terms

Aged
Aorta
Aortic Dissection* / surgery
Heart
Humans
Middle Aged
Perfusion
Postoperative Complications* / epidemiology
Postoperative Complications* / etiology

Grants and funding

Publication of this paper was supported by the University of Medicine and Pharmacy Carol Davila, through the institutional program Publish not Perish.