Neurologic Dysfunction After Acute Aortic Dissection Type A: A Long-Term Analysis of the German Registry for Acute Aortic Dissection Type A.

OBJECTIVES

The "German Registry for Acute Aortic Dissection Type A" (GERAADA) long-term follow-up firstly investigates the neurologic outcomes over a 16-year timeframe and secondly determines whether acute Stanford type A aortic dissection (ATAAD) patients are at risk for secondary neurologic complications.

METHODS

Thirty-three centres provided follow-up data of 2686 individuals. Of those, 814 provided long-term 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

Four hundred and fifteen (15%) out of the 2686 patients experienced postoperatively a new-onset neurologic deficit while being hospitalized. Age, renal malperfusion, dissected supra-aortic vessels, extracorporeal circulation time, and re-exploration were independent risk factors (all P < .05) for worse neurological outcomes while hemiarch replacement seemed to have a protective effect (OR = 0.68; P = .008). Neither cerebral protection strategy nor temperature management showed significant differences between the groups regarding neurological outcome. Out of the 814 follow-up patients, 188 (23%) experienced secondary neurologic deficits after initial treatment for ATAAD within a median follow-up of 10.2 years. Long-term risk factors were a persistent cerebral malperfusion and late reoperation. No association between perioperative neurologic damage and operative techniques on long-term neurologic outcomes could be found.

CONCLUSIONS

Surgery for ATAAD is associated with frequent early neurologic complications that can be predicted by perioperative factors. Open treatment of the aortic arch shows a positive effect on neurological outcome. Further, every fourth follow-upped patients suffered from secondary neurological damage highlighting the importance of a close surveillance.