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Postoperative Stroke After Type A Aortic Dissection Repair: Hemorrhage Versus Ischemia

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Abstract

Background

Postoperative stroke is a severe and potentially disabling complication following surgical intervention for acute type A aortic dissection (ATAAD). This retrospective study aims to compare the early and late outcomes between patients who had hemorrhagic and ischemic stroke after undergoing ATAAD repair surgery.

Methods

Between January 2007 and June 2020, a total of 685 consecutive patients underwent ATAAD repair at our institution. Patients who had a preoperative stroke or were unconscious at presentation were excluded from this study. Of the 656 included for analysis, 102 (15.5%) patients had a postoperative stroke confirmed by computed tomography angiography. The strokes were classified into the ischemia group (n = 83, 12.7%) and hemorrhage group (n = 19, 2.9%). Clinical features, surgical information, postoperative complications, modified Rankin Scale (mRS) scores after discharge, and 5-year cumulative survival rates were compared.

Results

Demographics, comorbidities, and presentations of ATAAD were similar between the two groups, except a higher rate of preoperative antithrombotic medication was found in the hemorrhage group. The hemorrhage group was associated with a higher complexity of aortic arch replacement, longer cardiopulmonary bypass, and aortic clamping times than the ischemia group. A higher in-hospital mortality rate (42.1% versus 20.5%; p = 0.048) and a higher median mRS score at the 3-month follow-up after discharge (6[3–6] versus 4[2–6]; p = 0.027) were found in the hemorrhage group. The hemorrhage group showed a lower 5-year cumulative survival rate (23.4% versus 57.8%; p = 0.003) compared with the ischemia group.

Conclusions

Postoperative hemorrhagic stroke was associated with poorer neurological outcomes and lower survival rates than those with ischemic stroke. Patients who have complex arch replacement, long cardiopulmonary bypass and aortic clamping times are at risk for postoperative hemorrhagic stroke and should have intensive neurological surveillance for early diagnosis and treatment after ATAAD repair surgery.

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Abbreviations

ACP:

Antegrade cerebral perfusion

AsAo:

Ascending aorta

ATAAD:

Acute type A aortic dissection

CI:

Confidence interval

CPB:

Cardiopulmonary bypass

ED:

Emergency department

eGFR:

Estimated glomerular filtration rate

ICU:

Intensive care unit

mRS:

Modified Rankin Scale

OR:

Odds ratio

OR:

Operating room

RCP:

Retrograde cerebral perfusion

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Authors and Affiliations

  1. Department of Medicine, College of Medicine, Chang Gung University, Taoyuan city, Taiwan

    Chun-Yu Lin, Hsin-Fu Lee, Meng-Yu Wu, Chi-Nan Tseng & Feng-Chun Tsai

  2. Department of Cardiothoracic and Vascular Surgery, New Taipei Municipal TuCheng Hospital, New Taipei city, Taiwan

    Chun-Yu Lin

  3. Department of Neurology, Mackay Memorial Hospital, Taipei city, Taiwan

    Chuo-Yu Lee

  4. Department of Cardiology, New Taipei Municipal TuCheng Hospital, New Taipei city, Taiwan

    Hsin-Fu Lee

  5. Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan city, Taiwan

    Meng-Yu Wu, Chi-Nan Tseng & Feng-Chun Tsai

  6. Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Township, Miaoli County, 35053, Taiwan

    Yu-Hsuan Lin

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  1. Chun-Yu Lin
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Lin, CY., Lee, CY., Lee, HF. et al. Postoperative Stroke After Type A Aortic Dissection Repair: Hemorrhage Versus Ischemia. World J Surg 46, 690–700 (2022). https://doi.org/10.1007/s00268-021-06375-y

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  • DOI: https://doi.org/10.1007/s00268-021-06375-y

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