Emergency operation for acute type A aortic dissection: Neurologic complications and early mortality

Background. Acute type A aortic dissection is a surgical emergency still as sociated with high postoperative complications. The aim of this study was t o investigate factors for hospital mortality and neurologic deficit in pati ents undergoing emergency operation for acute type A aortic dissection. Methods. Eighty-five consecutive patients (age range, 20 to 82 years) opera ted on for acute type A aortic dissection over a 6-year period were evaluat ed. Univariate and stepwise multiple logistic regression analyses were cond ucted among 32 perioperative variables. Results. All patients underwent surgical procedures under deep hypothermic circulatory arrest. Antegrade or retrograde cerebral perfusion was used in 23 patients (27.1%) and 18 patients (21.2%), respectively. Forty-three pati ents underwent arch/hemiarch replacement and the ascending aorta was replac ed in 42 patients. Overall mortality rate was 25.9% (22 of 85 patients). Mu ltiple logistic regression analysis showed that lack of cerebral perfusion (p = 0.021) and postoperative renal failure (p = 0.006) were the best predi ctors for hospital death. Twenty-one patients (24.7%) experienced neurologi c accidents. The risk factor for postoperative neurologic complication was lack of cerebral perfusion (p = 0.013). Hospital mortality was 13% (3 of 23 patients) and 16.7% (3 of 18 patients) in the antegrade and retrograde cer ebral perfusion groups (p > 0.05) and neurologic deficit was 13% (3 of 23 p atients) and 11.1% (2 of 18 patients), respectively (p > 0.05). Conclusions. Hospital mortality and neurologic complications in patients un dergoing emergent operation for acute type A aortic dissection were reduced when cerebral perfusion was used with deep hypothermic circulatory arrest. (Ann Thorac Surg 2001;71:33-8) (C) 2001 by The Society of Thoracic Surgeon s.