Is surgery in acute aortic dissection type A still contraindicated in the presence of preoperative neurological symptoms?

Most, Henriette; Reinhard, Brigitta; Gahl, Brigitta; Englberger, Lars; Kadner, Alexander; Weber, Alberto; Schmidli, Jürg; Carrel, Thierry; Huber, Christoph (2015). Is surgery in acute aortic dissection type A still contraindicated in the presence of preoperative neurological symptoms? European journal of cardio-thoracic surgery, 48(6), pp. 945-950. Oxford University Press 10.1093/ejcts/ezu538

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OBJECTIVES Severe neurological deficit (ND) due to acute aortic dissection type A (AADA) was considered a contraindication for surgery because of poor prognosis. Recently, more aggressive indication for surgery despite neurological symptoms has shown acceptable postoperative clinical results. The aim of this study was to evaluate early and mid-term outcomes of patients with AADA presenting with acute ND. METHODS Data from 53 patients with new-onset ND who received surgical repair for AADA between 2005 and 2012 at our institution were retrospectively reviewed. ND was defined as focal motor or sensory deficit, hemiplegia, paraplegia, convulsions or coma. Neurological symptoms were evaluated preoperatively using the Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS), and at discharge as well as 3-6 months postoperatively using the mRS and National Institutes of Health Stroke Scale. Involvement of carotid arteries was assessed in the pre- and postoperative computed tomography. Logistic regression analysis was performed to detect predictive factors for recovery of ND. RESULTS Of the 53 patients, 29 (54.7%) showed complete recovery from focal ND at follow-up. Neurological symptoms persisted in 24 (45.3%) patients, of which 8 (33%) died without neurological assessment at follow-up. Between the two groups (patients with recovery and those with persisting ND), there was no significant difference regarding the duration of hypothermic circulatory arrest (28 ± 14 vs 36 ± 20 min) or severely reduced consciousness (GCS <8). Multivariate analysis showed significant differences for the preoperative mRS between the two groups (P < 0.007). A high preoperative mRS was associated with persistence of neurological symptoms (P < 0.02). Cardiovascular risk factors, age or involvement of supra-aortic branches were not predictive for persistence of ND. CONCLUSION More than half of our patients recovered completely from ND due to AADA after surgery. Severity of clinical symptoms had a predictive value. Patients suffering from AADA and presenting with ND before surgery should not be excluded from emergency surgery.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Most, Henriette; Gahl, Brigitta; Englberger, Lars; Kadner, Alexander; Weber, Alberto; Schmidli, Jürg; Carrel, Thierry and Huber, Christoph

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1010-7940

Publisher:

Oxford University Press

Language:

English

Submitter:

Sara Baumberger

Date Deposited:

20 Feb 2015 11:11

Last Modified:

01 Dec 2018 02:31

Publisher DOI:

10.1093/ejcts/ezu538

PubMed ID:

25605829

Uncontrolled Keywords:

Aortic dissection type A, Coma, Malperfusion, Neurological deficit, Recovery

BORIS DOI:

10.7892/boris.63365

URI:

https://boris.unibe.ch/id/eprint/63365

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