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Operative strokes after repair of acute type a dissections: predisposing factors and implications.

BACKGROUND
Type A aortic dissection is a surgical emergency with a high morbidity and mortality. Strokes occur in up to 25% and are among the most feared complications. This study aims to evaluate factors linked to stroke development and the implications of strokes on outcomes.


METHODS
Patients from 2000-2014 were stratified based on the development of stroke. Factors were compared between the groups using chi-square or Fisher's exact tests for categorical variables, and independent two-group t-tests for continuous variables. Impact on survival at 30 days, 1 and 5 years were evaluated using the life-test method.


RESULTS
200 patients were analyzed. 40 (20%) developed a stroke. Preoperative factors associated with stroke were female gender (34% vs 14% p=0.01), presentation with shock (32% vs 17%; p=0.035), and history of stroke (64% vs 17%; p < 0.001). Femoral cannulation was the only technical variable associated with stroke (49% vs 32%; p=0.035). Stroke patients had a higher rate of pneumonia (41% vs 11%; p<0.001), respiratory failure (36% vs 7%; p<0.001), hemodialysis requirement (38% vs 16%; p=0.015), and longer hospital stay (23.9 ± 17.8 days vs 16.1 ± 13.5 days; p=0.012). Stroke was associated with a lower survival probability at 30-days (0.73 vs 0.89), 1-year (0.56 vs 0.78) and 5-years (0.29 vs 0.70) (p<0.001).


CONCLUSIONS
Patients who developed stroke after type A dissection repair had higher complication rates and a higher mortality rate at 30 days, 1 year, and 5 years. Femoral cannulation was the only technical factor associated with a higher rate of strokes.