Risk factors for impaired neurological outcome after thoracic aortic surgery
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Risk factors for impaired neurological outcome after thoracic aortic surgery. / Demal, Till J; Sitzmann, Franziska W; Bax, Lennart; von Kodolitsch, Yskert; Brickwedel, Jens; Konertz, Johanna; Gaekel, Daniel M; Sadeq, Ahmed J; Kölbel, Tilo; Vettorazzi, Eik; Reichenspurner, Hermann; Detter, Christian.
in: J THORAC DIS, Jahrgang 14, Nr. 6, 06.2022, S. 1840-1853.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Risk factors for impaired neurological outcome after thoracic aortic surgery
AU - Demal, Till J
AU - Sitzmann, Franziska W
AU - Bax, Lennart
AU - von Kodolitsch, Yskert
AU - Brickwedel, Jens
AU - Konertz, Johanna
AU - Gaekel, Daniel M
AU - Sadeq, Ahmed J
AU - Kölbel, Tilo
AU - Vettorazzi, Eik
AU - Reichenspurner, Hermann
AU - Detter, Christian
N1 - 2022 Journal of Thoracic Disease. All rights reserved.
PY - 2022/6
Y1 - 2022/6
N2 - Background: We aimed to identify risk factors for an impaired postoperative neurological outcome after thoracic aortic surgery.Methods: Data from all patients undergoing thoracic aortic surgery between 2010 and 2020 at our institution were collected and analyzed retrospectively. Logistic regression analysis was used to identify independent risk factors for permanent postoperative neurological deficit (ND) (stroke), which was defined as a ND lasting at least seven days.Results: Thoracic aortic surgery was performed in 1,334 patients. Of these, 286 (21.4%) underwent emergency surgery. The mean EuroSCORE II was 8.6±10.1. A perioperative stroke occurred in 94 patients (7.0%). Of all strokes, 62.8% (n=59) were considered of embolic and 24.5% (n=23) of hemodynamic origin. In elective procedures, stroke rates ranged from 0.5% after valve-sparing root replacement to 8.1% after arch surgery. Adjusted logistic regression identified advanced age [>70 years; odds ratio (OR), 1.83; P=0.009], acute type A dissection (ATAD) (OR, 1.69; P=0.0495), aortic arch surgery (OR, 3.24; P<0.001), concomitant coronary artery bypass grafting (CABG) (OR, 2.19; P=0.005), and high extracorporeal circulation (ECC) time (>230 min; OR, 1.70; P=0.034) as independent risk factors for all strokes. Secondary endpoint analyses revealed that risk factors for hemodynamic stroke were arch surgery, advanced age (>70 years), atherosclerosis, and ATAD. Risk factors for embolic stroke were arch surgery, concomitant CABG and preoperative cerebral malperfusion.Conclusions: Identified independent risk factors for all strokes were advanced age, ATAD, arch surgery, concomitant CABG, and high ECC time. Hemodynamic and embolic strokes show distinct risk profiles.
AB - Background: We aimed to identify risk factors for an impaired postoperative neurological outcome after thoracic aortic surgery.Methods: Data from all patients undergoing thoracic aortic surgery between 2010 and 2020 at our institution were collected and analyzed retrospectively. Logistic regression analysis was used to identify independent risk factors for permanent postoperative neurological deficit (ND) (stroke), which was defined as a ND lasting at least seven days.Results: Thoracic aortic surgery was performed in 1,334 patients. Of these, 286 (21.4%) underwent emergency surgery. The mean EuroSCORE II was 8.6±10.1. A perioperative stroke occurred in 94 patients (7.0%). Of all strokes, 62.8% (n=59) were considered of embolic and 24.5% (n=23) of hemodynamic origin. In elective procedures, stroke rates ranged from 0.5% after valve-sparing root replacement to 8.1% after arch surgery. Adjusted logistic regression identified advanced age [>70 years; odds ratio (OR), 1.83; P=0.009], acute type A dissection (ATAD) (OR, 1.69; P=0.0495), aortic arch surgery (OR, 3.24; P<0.001), concomitant coronary artery bypass grafting (CABG) (OR, 2.19; P=0.005), and high extracorporeal circulation (ECC) time (>230 min; OR, 1.70; P=0.034) as independent risk factors for all strokes. Secondary endpoint analyses revealed that risk factors for hemodynamic stroke were arch surgery, advanced age (>70 years), atherosclerosis, and ATAD. Risk factors for embolic stroke were arch surgery, concomitant CABG and preoperative cerebral malperfusion.Conclusions: Identified independent risk factors for all strokes were advanced age, ATAD, arch surgery, concomitant CABG, and high ECC time. Hemodynamic and embolic strokes show distinct risk profiles.
U2 - 10.21037/jtd-21-1591
DO - 10.21037/jtd-21-1591
M3 - SCORING: Journal article
C2 - 35813705
VL - 14
SP - 1840
EP - 1853
JO - J THORAC DIS
JF - J THORAC DIS
SN - 2072-1439
IS - 6
ER -
