Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

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DOI

  • Raphaelle A Chemtob, Heart and Vascular Institute
  • ,
  • Simon Fuglsang Simonsen
  • Arnar Geirsson, Yale School of Medicine, Yale University
  • ,
  • Anders Ahlsson, Karolinska Univ Hosp, Karolinska Institutet, Karolinska University Hospital
  • ,
  • Christian Olsson, Karolinska Univ Hosp, Karolinska Institutet, Karolinska University Hospital
  • ,
  • Jarmo Gunn, Turku PET Centre and Division of Clinical Neurosciences Turku, University of Turku and Turku University Hospital, Turku, Finland.
  • ,
  • Khalil Ahmad
  • Emma C Hansson, Univ Gothenburg, Sahlgrenska University Hospital, University of Gothenburg, Sahlgrenska Acad, Sahlgrenska Univ Hosp, Dept Orthopaed
  • ,
  • Emily Pan, Turku PET Centre and Division of Clinical Neurosciences Turku, University of Turku and Turku University Hospital, Turku, Finland.
  • ,
  • Linda O Arnadottir, Univ Iceland, Landspitali National University Hospital, University of Iceland, Natl Univ Hosp Iceland
  • ,
  • Ari Mennander, Heart Center Tampere University Hospital and University of Tampere
  • ,
  • Shahab Nozohoor, Department of Nephrology in Lund, Clinical Sciences Lund, Skåne University Hospital and Lund University, Lund, Sweden.
  • ,
  • Anders Wickbom, b Orebro University Hospital , Orebro , Sweden.
  • ,
  • Igor Zindovic, Department of Nephrology in Lund, Clinical Sciences Lund, Skåne University Hospital and Lund University, Lund, Sweden.
  • ,
  • Aldina Pivodic, Univ Gothenburg, University of Gothenburg, Gothenburg Global Biodivers Ctr
  • ,
  • Anders Jeppsson, Univ Gothenburg, Sahlgrenska University Hospital, University of Gothenburg, Sahlgrenska Acad, Sahlgrenska Univ Hosp, Dept Orthopaed
  • ,
  • Vibeke Hjortdal
  • Tomas Gudbjartsson, Univ Iceland, Landspitali National University Hospital, University of Iceland, Natl Univ Hosp Iceland

OBJECTIVES: Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients.

METHODS: The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014.

RESULTS: Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34-3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27-2.23; P < 0.001).

CONCLUSIONS: Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.

Original languageEnglish
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume58
Issue5
Pages (from-to)1027-1034
Number of pages8
ISSN1010-7940
DOIs
Publication statusPublished - 2020

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