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Outcomes following repair of acute type A aortic dissection in patients with cerebral malperfusion

Ede, Jacob LU orcid ; Teurneau-Hermansson, Karl LU orcid ; Ramgren, Birgitta LU ; Moseby-Knappe, Marion LU ; Larsson, Mårten LU ; Sjögren, Johan LU ; Wierup, Per LU ; Nozohoor, Shahab LU orcid and Zindovic, Igor LU (2025) In Scandinavian Cardiovascular Journal 59(1).
Abstract

Objectives: Patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion have significantly poorer postoperative outcomes, making the decision whether to perform acute surgery difficult. The aim of this study was to investigate types of neurological symptoms and radiological findings and their association with permanent neurological injury and mortality following ATAAD repair. Methods: This was a single-center, retrospective, observational study. A total of 629 patients underwent ATAAD surgery between January 1998 and December 2023 at Skåne University Hospital, Lund, Sweden. Of these, 93 (14.7%) presented with cerebral malperfusion and constituted the study population. The primary endpoints were clinical... (More)

Objectives: Patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion have significantly poorer postoperative outcomes, making the decision whether to perform acute surgery difficult. The aim of this study was to investigate types of neurological symptoms and radiological findings and their association with permanent neurological injury and mortality following ATAAD repair. Methods: This was a single-center, retrospective, observational study. A total of 629 patients underwent ATAAD surgery between January 1998 and December 2023 at Skåne University Hospital, Lund, Sweden. Of these, 93 (14.7%) presented with cerebral malperfusion and constituted the study population. The primary endpoints were clinical neurological injury and 30-day mortality. Results: Overall 30-day mortality was 25.0%. Fifty-two patients (57.1%) had persisting neurological deficit. Patients with postoperative neurological deficit had significantly higher 30-day mortality than patients without postoperative neurological deficit (37.3% vs 5.1%, p > 0.001). Common carotid artery dissection and carotid artery occlusion were significantly more frequent in patients who developed postoperative neurological injury. Preoperative hemiparesis/hemiplegia was associated with a significant increase of persisting neurological deficits, and unconsciousness was associated with a significant increase in 30-day mortality or persisting neurological deficits. After repair, 52.2% of patients showed an improvement in their clinical neurological status. Conclusion: In ATAAD patients who present with cerebral malperfusion, the risk of permanent neurological deficit and 30-day mortality is high, but a significant proportion of patients survive and more than half demonstrate an improved neurological state postoperatively.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute type A aortic dissection, Aortic dissection, cardiac surgery, cerebral malperfusion, stroke
in
Scandinavian Cardiovascular Journal
volume
59
issue
1
article number
2514742
publisher
Taylor & Francis
external identifiers
  • scopus:105007623928
  • pmid:40455782
ISSN
1401-7431
DOI
10.1080/14017431.2025.2514742
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
id
62015032-0c32-4d77-ad2b-c554fe823a72
date added to LUP
2025-12-22 10:45:28
date last changed
2025-12-23 03:00:08
@article{62015032-0c32-4d77-ad2b-c554fe823a72,
  abstract     = {{<p>Objectives: Patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion have significantly poorer postoperative outcomes, making the decision whether to perform acute surgery difficult. The aim of this study was to investigate types of neurological symptoms and radiological findings and their association with permanent neurological injury and mortality following ATAAD repair. Methods: This was a single-center, retrospective, observational study. A total of 629 patients underwent ATAAD surgery between January 1998 and December 2023 at Skåne University Hospital, Lund, Sweden. Of these, 93 (14.7%) presented with cerebral malperfusion and constituted the study population. The primary endpoints were clinical neurological injury and 30-day mortality. Results: Overall 30-day mortality was 25.0%. Fifty-two patients (57.1%) had persisting neurological deficit. Patients with postoperative neurological deficit had significantly higher 30-day mortality than patients without postoperative neurological deficit (37.3% vs 5.1%, p &gt; 0.001). Common carotid artery dissection and carotid artery occlusion were significantly more frequent in patients who developed postoperative neurological injury. Preoperative hemiparesis/hemiplegia was associated with a significant increase of persisting neurological deficits, and unconsciousness was associated with a significant increase in 30-day mortality or persisting neurological deficits. After repair, 52.2% of patients showed an improvement in their clinical neurological status. Conclusion: In ATAAD patients who present with cerebral malperfusion, the risk of permanent neurological deficit and 30-day mortality is high, but a significant proportion of patients survive and more than half demonstrate an improved neurological state postoperatively.</p>}},
  author       = {{Ede, Jacob and Teurneau-Hermansson, Karl and Ramgren, Birgitta and Moseby-Knappe, Marion and Larsson, Mårten and Sjögren, Johan and Wierup, Per and Nozohoor, Shahab and Zindovic, Igor}},
  issn         = {{1401-7431}},
  keywords     = {{acute type A aortic dissection; Aortic dissection; cardiac surgery; cerebral malperfusion; stroke}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Cardiovascular Journal}},
  title        = {{Outcomes following repair of acute type A aortic dissection in patients with cerebral malperfusion}},
  url          = {{http://dx.doi.org/10.1080/14017431.2025.2514742}},
  doi          = {{10.1080/14017431.2025.2514742}},
  volume       = {{59}},
  year         = {{2025}},
}