Factors associated with acute stroke after type A aortic dissection repair: An analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database

医学 冲程(发动机) 脑灌注压 优势比 腋动脉 体外循环 外科 心胸外科 麻醉 主动脉夹层 心脏外科 心脏病学 灌注 内科学 主动脉 机械工程 工程类
作者
Mehrdad Ghoreishi,Thoralf M. Sundt,Duke E. Cameron,Sari D. Holmes,Eric E. Roselli,Chetan Pasrija,James S. Gammie,Himanshu J. Patel,Joseph E. Bavaria,Lars G. Svensson,Bradley S. Taylor
出处
期刊:The Journal of Thoracic and Cardiovascular Surgery [Elsevier BV]
卷期号:159 (6): 2143-2154.e3 被引量:120
标识
DOI:10.1016/j.jtcvs.2019.06.016
摘要

ObjectivesData from the Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to examine the incidence and factors associated with acute stroke following type A repair.MethodsAcute type A aortic dissection repairs performed from 2014 to 2017 were identified from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The effect of cannulation strategy (eg, axillary, femoral, direct, or innominate), lowest temperature, cerebral protection techniques (antegrade cerebral profusion, retrograde cerebral perfusion, both, or none), repair technique, and institutional volume on postoperative stroke was investigated.ResultsAcute type A repair was performed on 8937 patients at 772 centers, of which 7353 met inclusion criteria. Operative mortality was 17% and incidence of postoperative stroke was 13%. Axillary cannulation was associated with lower risk of stroke versus femoral (odds ratio, 0.60; P < .001). Retrograde cerebral perfusion was associated with reduced risk for stroke compared with no cerebral perfusion (odds ratio, 0.75; P = .008) or antegrade cerebral perfusion (odds ratio, 0.75; P = .007). Total arch replacement was associated with greater risk for stroke versus hemiarch technique (odds ratio, 1.30; P = .013). Longer circulatory arrest time, cerebral perfusion time, and cardiopulmonary bypass time were all related to higher risk of postoperative stroke.ConclusionsStroke is a common complication after type A repair. Axillary cannulation was associated with lower incidence of stroke, whereas femoral cannulation significantly increased the risk of stroke regardless of the cerebral perfusion strategy or the degree of hypothermia. Retrograde cerebral profusion was found to have reduced risk for postoperative stroke. Degree of hypothermia and center volume were not related to stroke incidence.
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