Auswirkungen von präoperativen dissektionsbedingten neurologischen Defiziten auf das Outcome bei Patienten mit einer Typ A Aortendissektion nach Stanford
Acute aortic dissection Type A (AADA) is a life-threatening surgical emergency with high mortality rates.It has previously been shown that preoperative dissection-related neurological deficits (DRND) are associated with worse prognosis after surgical treatment. This study aims to examine the influence of cerebral malperfusion on peri- and postoperative parameters to identify its precise impact on outcomes after AADA. Results:In our analysis, 82 patients (17.1%) presented preoperative DRND, such as transient ischemic attack or stroke. Supracoronary ascending aortic replacement was the most frequent surgical strategy in both groups, although significantly more frequent in patients with DRND (92.7 vs. 82.4%, p=0.020), as non-DRND-patients underwent more Bentall procedures (22.4 vs. 8.5%, p=0.004) and aortic valve replacements (21.6 vs. 6.1%, p=0.001).In terms of perioperative management, patients with DRND showed a significantly higher intraoperative need for blood products, requiring more erythrocyte concentrates (4 vs. 2, p<0.001) compared to the control group.During postoperative treatment, patients with DRND required longer mechanical ventilation (109hrs vs. 43hrs, p<0.001) as well as a higher number of tracheotomies (35.4% vs. 20.7%, p=0.004). In addition, they had a higher rate of postoperative new neurological damage (35.4% vs 19.4%, p=0.002) and acute kidney injury, requiring longer periods of dialysis (6 vs. 3 d, p=0.010).This led to longer stays in ICU (7 vs. 5 d, p=0.013) in patients with DRND. Even though there was no significance in the analysed patient cohort, patients with DRND tended to have a higher rate of 30-d mortality (22.0% vs. 17.6%, p=0.349). Long-term survival after 30 days was poorer in the DRND-group (Log Rank p=0.004).Conclusion:Our study confirms that AADA patients with pre-operative DRND require more intense peri- and postoperative treatment, suffer more complications and have worse long-term outcomes.
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