Neurologic Dysfunction after Acute Aortic Dissection Type A (AADA): A Long-Term Analysis of the German Registry for Acute Aortic Dissection Type A (GERAADA)

Background: Analyses from GERAADA provided data for perioperative neurologic dysfunction, which was shown to be associated with an increased mortality. GERAADA long-term follow-up investigates the neurologic outcomes over a 16-year timeframe to determine whether AADA patients are at risk for secondary neurologic complications.

Method: Thirty-three centers participated in the long-term follow-up and provided data of 2,686 individuals. In a mean follow-up timeframe of 10.2 years, 1,164 patients died, 1,063 survived, and 459 were lost to follow-up. Out of the surviving population, 814 provided data regarding their neurological status and incidence of stroke. Multivariable regression analysis was used to identify risk factors of both postoperative and secondary neurologic deficits. Subgroup analyses of patients operated in hypothermic circulatory arrest with or without selective antegrade cerebral perfusion was performed to assess further influencing factors.

Results: A total of 415 (15.5%) out of the 2,686 patients experienced a postoperative neurologic deficit while being hospitalized which did not exist preoperatively. Age, malperfusion (renal or peripheral), supraaortic dissection, extracorporeal circulation time and reexploration were independent risk factors (all p < 0.05) for worse neurological outcomes while hemi-arch replacements seemed to have a protective effect compared with patients only receiving a replacement of the ascending aorta (OR = 0.68; p = 0.008). For patients undergoing surgery in isolated hypothermic circulatory arrest or with adjunct selective antegrade cerebral perfusion, moderate and mild hypothermia, respectively, had the lowest incidence of neurologic complications (both 14.1%) but ultimately failed to reach statistical significance (p = 0.63). 188 (23.1%) out of the surviving 814 follow-up patients experienced secondary neurologic complications after initial treatment for AADA. Long-term risk factors were a persistent cerebral malperfusion and late reoperation. In addition to that, no association between perioperative neurologic damage and operative techniques on long-term neurologic outcomes could be found.

Conclusion: Surgery for AADA is associated with frequent early neurologic complications that can be predicted by perioperative factors. Open treatment of the aortic arch helps to ensure adequate cerebral perfusion. Further, persistent cerebral malperfusion should be addressed since it is associated with secondary neurological damage.

Publication History

Article published online:
28 January 2023