Barnabo Nampoukime Kan-paatib, Monteiro Igwenandji Adeoumi Esperance, Pan You Min, Wang Hai Hao*
Objective: The objective of this retrospective study was to establish a relationship between the locations of the primary entry tear in acute type A aortic dissections and the occurrence of postoperative neurological dysfunction
Methods: From January 2018 to December 2019, a total of 316 patients diagnosed with type A acute aortic dissection underwent conventional surgical repair. The patients were divided into two study groups based on the location of the primary tear in the aorta and the presence of postoperative neurological dysfunction. Propensity score-matching analysis was employed to compare outcomes between the groups and reduce selection bias.
Results: The incidence of neurological dysfunction was 10.75% (34 patients). Hypertension demonstrated a high Odd Ratio (OR) of 76.7 (95% Confidence Interval (CI) 15.0-1,385; p<0.001). The cerebral protection strategy showed a low odds ratio of 0.16 (95% CI 0.05-0.47; p=0.001), while the arterial cannulation site had an odds ratio of 0.16 (95% CI 0.05-0.47; p=0.003). Aortic cross-clamping time displayed an odds ratio of 1.03 (95% CI 1.01-1.05; p=0.001) and CPB time had an odds ratio of 1.01 (95% CI 1.00-1.02; p=0.025). Body temperature revealed an odds ratio of 0.20 (95% CI 0.10-0.35; p<0.001). These factors were identified as independent predictors of postoperative neurological dysfunction in a group of studies based on the location of the primary tear.
Conclusion: Hypertension was found to be independently associated with postoperative neurological dysfunction. Furthermore, patients with aortic dissection involving the aortic arch are at a higher risk of developing postoperative neurological dysfunction, with intraoperative factors such as the cerebral protection strategy, arterial cannulation site, aortic cross-clamping time and body temperature acting as risk factors. The location of the primary tear and the involvement of the aortic arch in ATAAD are significant determinants of postoperative neurological outcomes.
Published Date: 2025-02-13; Received Date: 2024-02-26
