Analysis of Postoperative Stroke Following Emergent Type-A Aortic Dissection Repair

Background: To investigate the incidence, risk factors and clinical consequence of postoperative stroke in patients undergoing immediate Type-A dissection repair.

Methods: A single-center, retrospective study was conducted on a cohort of 628 patients undergoing immediate surgical repair with direct admission to the operating room between 10/2001 and 10/2020. Postoperatively, the modified Rankin Scale (mRS) was used to quantify a postoperative stroke. A comparative analysis was performed between patients who experienced postoperative strokes and those who did not.

Results: Postoperative stroke was detected in 21.5% (n = 135) of the patients. In these patients preoperative cardiopulmonary resuscitation (stroke: n = 12 [9%] vs. no stroke: 15 [3%], p = 0.005), malperfusion syndrome (stroke: n = 68 [50%] vs. no stroke: n = 127 [26%], p = 0.001), and a preoperative new neurologic deficit (stroke: n = 60 [44%] vs. no stroke: 53 [11%], p = 0.001) were significantly more common. Also, supra-aortic vessel dissection was significantly more common in stroke patients (stroke: n = 96 [71%] vs. no stroke: 228 [46%], p = 0.001). There were no statistically significant differences regarding intraoperative data. Postoperative stroke had a substantial impact on morbidity and was associated with elevated rates of postoperative complications and significantly increased in-hospital mortality (stroke: n = 33 [24%] vs. no stroke: 61 [12%], p = 0.001). Yet, 45 (33%) of all stroke patients were discharged with a good neurologic outcome (mRS 0–2). History of a prior stroke (OR: 5.81, p < 0.001), preoperative shock (OR: 1.74, p = 0.021), malperfusion syndrome (OR: 2.01, p = 0.002), and supra-aortic vessel dissection (OR: 2.36, p < 0.001) were significant predictors for a postoperative stroke. A postoperative hemorrhagic transformation was observed in 12 (9%) of all stroke patients.

Conclusion: In patients with Type-A aortic dissection, the involvement of supra-aortic vessels and a prior history of stroke serve as strong predictors for the occurrence of postoperative strokes, while the presence of preoperative cardiopulmonary resuscitation (CPR) does not exhibit a significant predictive value. A surgical intervention is deemed reasonable for all patients, as approximately one third of stroke cases result in either no or minimal disability (i.e., modified Rankin Scale ≤ 2). Furthermore, surgeons need to be aware of the risk for postoperative hemorrhagic transformation in these patients.

Publication History

Article published online:
13 February 2024