Association between Bilateral Selective Antegrade Cerebral Perfusion and Postoperative Ischemic Stroke in Patients with Emergency Surgery for Acute Type A Aortic Dissection—Single Centre Experience
Abstract
:1. Introduction
2. Methods
2.1. Surgical Technique
2.2. Statistical Analysis
3. Results
Logistic Regression
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter (Unit) | n = 129 (100%) |
---|---|
Age (mean, SD) | 59 (11.15) |
Gender (n, % male) | 83 (64.3%) |
Euroscore (mean, SD) | 9.03 (2.63) |
Time from diagnostic CT to surgery (hours) | 4.89 (4.375) |
Arterial Hypertension (n, %) | 85 (65.9%) |
Diabetes (n, %) | 8 (6.2%) |
Dyslipidemia (n, %) | 40 (31%) |
Chronic Kidney Disease (n, %) | 10 (7.8%) |
Preoperative Atrial Fibrillation (n, %) | 12 (9.3%) |
Bicuspid Aortic Valve (n, %) | 11 (8.5%) |
Cardiac Tamponade at Admission (n, %) | 35 (27.1%) |
Dissection of Innominate Artery (n, %) | 33 (25.6%) |
Dissection of Left Common Carotid Artery (n, %) | 21 (16.3%) |
Dissection of Innominate Artery and Left Common Carotid Artery (n, %) | 9 (6.97%) |
Severe Aortic Regurgitation (n, %) | 24 (18.6%) |
Mild left ventricular dysfunction (LVEF 40–50%) (n, %) | 9 (7%) |
Moderate left ventricle dysfunction (LVEF 30–40%) (n, %) | 2 (1.6%) |
Severe left ventricle dysfunction (LVEF < 30%) (n, %) | 1 (0.8%) |
Severe calcifications of ascending aorta or aortic arch (n, %) | 9 (7%) |
Death Cause | No (%) |
---|---|
Cardiogenic shock | 7 (5.4) |
Septic shock | 12 (9.3) |
Hemorrhagic stroke | 2 (1.6) |
Mixed shock (cardiogenic and septic) | 6 (4.7) |
Parameter (Unit) | n = 129 (100%) |
---|---|
Type of operation | |
Supracoronary ascending aorta and Hemiarch replacement (n, %) | 90 (69.8%) |
Supracoronary ascending aorta and arch replacement (n, %) | 20 (15.5%) |
Aortic root, ascending aorta, and Hemiarch replacement (n, %) | 14 (10.9%) |
Supracoronary ascending aorta replacement (n, %) | 3 (2.3%) |
Aortic root, ascending aorta, and arch replacement (n, %) | 1 (0.8%) |
Combined procedures | 13 (10.07%) |
Mitral valve replacement (n, %) | 4 (3.1%) |
Coronary artery bypass grafting (n, %) | 6 (4.65%) |
Peripheral V-A ECMO (n, %) | 1 (0,8%) |
Femorofemoral Bypass (n, %) | 1 (0.8%) |
Aortic coarctation repair (n, %) | 1 (0.8%) |
Cannulation site | |
Axillary artery (n, %) | 88 (68.2%) |
Femoral artery (n, %) | 39 (30.2%) |
Aortic arch (n, %) | 2 (1.6%) |
Primary entry tear | |
Ascending aorta/aortic root (n, %) | 56 (43.4%) |
Aortic arch (n, %) | 42 (32.6%) |
Ascending aorta/aortic root and aortic arch (n, %) | 12 (9.3%) |
Not found in the aortic arch or ascending aorta/aortic root (n, %) | 18 (14%) |
Cardiopulmonary bypass time (min); (mean, SD) | 210 (56,874) |
Aortic cross-clamp time (min); (mean, SD) | 114,775 (34,602) |
Cerebral perfusion time (min); (mean, SD) | 37,837 (18,243) |
Cerebral perfusion below 30 min (n, %) | 57 (44.2) |
Cerebral perfusion between 30 and 40 min (n, %) | 44 (34.1) |
Cerebral perfusion over 40 min (n, %) | 41 (31.8) |
Postoperative atrial fibrillation (n, %) | 34 (26.4) |
Subsequent intervention for bleeding (n, %) | 34 (26.4) |
mRS | n/(100%) |
0 | 0 (0%) |
1 | 3 (9.67%) |
2 | 5 (16.12%) |
3 | 6 (19.35%) |
4 | 4 (12.90%) |
5 | 0 (0%) |
6 | 13 (41.93%) |
Univariate Analysis | Multivariable Analysis | |||||
---|---|---|---|---|---|---|
OR | 95%CI | p | OR | 95%CI | p | |
LCCAD | 2.772 | 1.041–7.381 | 0.041 | 2.941 | 1.034–8.364 | 0.043 |
Dyslipidemia | 3.048 | 1.077–8.627 | 0.036 | 4.577 | 1.462–14.332 | 0.009 |
BSACP > 40 | 2.41 | 1.054–5.509 | 0.037 | 3.589 | 1.418–9.085 | 0.007 |
OR | 95%CI | p | |
---|---|---|---|
BSACP 30–40 min | 1.016 | 0.438–2.357 | 0.971 |
BSACP < 30 min | 0.484 | 0.207–1.128 | 0.093 |
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Robu, M.; Marian, D.R.; Margarint, I.; Radulescu, B.; Știru, O.; Iosifescu, A.; Voica, C.; Cacoveanu, M.; Ciomag, R.; Gașpar, B.S.; et al. Association between Bilateral Selective Antegrade Cerebral Perfusion and Postoperative Ischemic Stroke in Patients with Emergency Surgery for Acute Type A Aortic Dissection—Single Centre Experience. Medicina 2023, 59, 1365. https://doi.org/10.3390/medicina59081365
Robu M, Marian DR, Margarint I, Radulescu B, Știru O, Iosifescu A, Voica C, Cacoveanu M, Ciomag R, Gașpar BS, et al. Association between Bilateral Selective Antegrade Cerebral Perfusion and Postoperative Ischemic Stroke in Patients with Emergency Surgery for Acute Type A Aortic Dissection—Single Centre Experience. Medicina. 2023; 59(8):1365. https://doi.org/10.3390/medicina59081365
Chicago/Turabian StyleRobu, Mircea, Diana Romina Marian, Irina Margarint, Bogdan Radulescu, Ovidiu Știru, Andrei Iosifescu, Cristian Voica, Mihai Cacoveanu, Raluca Ciomag (Ianula), Bogdan Severus Gașpar, and et al. 2023. "Association between Bilateral Selective Antegrade Cerebral Perfusion and Postoperative Ischemic Stroke in Patients with Emergency Surgery for Acute Type A Aortic Dissection—Single Centre Experience" Medicina 59, no. 8: 1365. https://doi.org/10.3390/medicina59081365
APA StyleRobu, M., Marian, D. R., Margarint, I., Radulescu, B., Știru, O., Iosifescu, A., Voica, C., Cacoveanu, M., Ciomag, R., Gașpar, B. S., Dorobanțu, L., Iliescu, V. A., & Moldovan, H. (2023). Association between Bilateral Selective Antegrade Cerebral Perfusion and Postoperative Ischemic Stroke in Patients with Emergency Surgery for Acute Type A Aortic Dissection—Single Centre Experience. Medicina, 59(8), 1365. https://doi.org/10.3390/medicina59081365