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DOI: 10.1055/s-0040-1705514
Risk Factors for Impaired Neurological Outcome in Aortic Surgery
Publication History
Publication Date:
13 February 2020 (online)
Objectives: Neurological complications like transient ischemic attack, paresis, and stroke still frequently occur during aortic surgery. We sought to evaluate risk factors for an impaired neurological outcome.
Methods: We registered 751 patients who underwent aortic surgery between 1998 and 2019 at our center. Risk factors for the occurrence of postoperative permanent neurological deficit (PND) were identified using logistic regression analysis in a retrospective analysis. Furthermore, we analyzed the influence of a simplified frozen elephant trunk (FET) technique (resection of the supra-aortic vessels distally from its origin, arterial cannulation via the left subclavian artery, and distal anastomosis in aortic arch zone 2) on neurological outcome.
Results: Mean age was 65.6 ± 13.3 years and 63.6% (n = 478) of the patients were male. The most common indications for aortic surgery were thoracic aneurysms in 45.7% (n = 342), acute dissections in 41.6% (n = 304), and chronic dissections in 8.8% (n = 64). Surgical treatment consisted of isolated ascending aortic replacement in 35.6% (n = 267), hemiarch replacement in 42.3% (n = 318), and total arch replacement in 22.1% (n = 166). Frozen elephant trunk technique (FET) was used in 15.4% (n = 116) of the cases.
The overall postoperative PND rate was 14.7% (n = 104). Using logistic regression analysis, we identified emergency treatment (adjusted OR = 3.1; p = 0.024) and additional coronary artery bypass grafting (CABG) (adjusted OR = 2.3; p = 0.023) as risk factors for postoperative PND. Furthermore, acute type A dissection patients tended to be at higher risk for PND (adjusted OR = 2.4; p = 0.055).
Total arch replacement (p = 0.381) and FET technique (p = 0.424) did not increase the risk for PND. A simplified FET technique could be identified as protective factor against postoperative PND (simplified technique: 3.8% [n = 2]; conventional technique: 20.4% [n = 22]; adjusted OR = 0.2; p = 0.042).
Conclusion: In aortic surgery, especially patients undergoing emergency treatment or additional CABG are at high risk of neurological complications. Using a simplified FET technique, the stroke rate in aortic arch surgery can be significantly reduced.