A1 Refereed original research article in a scientific journal
Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)
Authors: Chemtob R.A., Fuglsang S., Geirsson A., Ahlsson A., Olsson C., Gunn J., Ahmad K., Hansson E.C., Pan E., Arnadottir L.O., Mennander A., Nozohoor S., Wickbom A., Zindovic I., Pivodic A., Jeppsson A., Hjortdal V., Gudbjartsson T.
Publication year: 2020
Journal: European Journal of Cardio-Thoracic Surgery
Journal name in source: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume: 58
Issue: 5
First page : 1027
Last page: 1034
ISSN: 1873-734X
DOI: https://doi.org/10.1093/ejcts/ezaa197
OBJECTIVES
Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients.
METHODS
The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014.
RESULTS
Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34–3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27–2.23; P < 0.001).
CONCLUSIONS
Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.
