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Ann Thorac Surg 2001;71:33-38
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Emergency operation for acute type A aortic dissection: neurologic complications and early mortality

Riccardo Sinatra, MDa, Giovanni Melina, MDa, Ivana Pulitani, MDa, Brenno Fiorani, MDa, Giovanni Ruvolo, MDa, Benedetto Marino, MDa

a Department of Cardiac Surgery, University of Rome "La Sapienza," Rome, Italy

Accepted for publication May 24, 2000.

Address reprint requests to Dr Sinatra, Istituto di Chirurgia del Cuore e dei Grossi Vasi, Policlinico Umberto I, Università "La Sapienza," Viale del Policlinico 155, 00161 Roma, Italia
e-mail: rsinatra{at}uniroma1.it

Background. Acute type A aortic dissection is a surgical emergency still associated with high postoperative complications. The aim of this study was to investigate factors for hospital mortality and neurologic deficit in patients undergoing emergency operation for acute type A aortic dissection.

Methods. Eighty-five consecutive patients (age range, 20 to 82 years) operated on for acute type A aortic dissection over a 6-year period were evaluated. Univariate and stepwise multiple logistic regression analyses were conducted among 32 perioperative variables.

Results. All patients underwent surgical procedures under deep hypothermic circulatory arrest. Antegrade or retrograde cerebral perfusion was used in 23 patients (27.1%) and 18 patients (21.2%), respectively. Forty-three patients underwent arch/hemiarch replacement and the ascending aorta was replaced in 42 patients. Overall mortality rate was 25.9% (22 of 85 patients). Multiple logistic regression analysis showed that lack of cerebral perfusion (p = 0.021) and postoperative renal failure (p = 0.006) were the best predictors for hospital death. Twenty-one patients (24.7%) experienced neurologic accidents. The risk factor for postoperative neurologic complication was lack of cerebral perfusion (p = 0.013). Hospital mortality was 13% (3 of 23 patients) and 16.7% (3 of 18 patients) in the antegrade and retrograde cerebral perfusion groups (p > 0.05) and neurologic deficit was 13% (3 of 23 patients) and 11.1% (2 of 18 patients), respectively (p > 0.05).

Conclusions. Hospital mortality and neurologic complications in patients undergoing emergent operation for acute type A aortic dissection were reduced when cerebral perfusion was used with deep hypothermic circulatory arrest.




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