Radiological properties of neurological injury following acute type A aortic dissection repair
Ede, Jacob LU
; Teurneau-Hermansson, Karl
LU
; Ramgren, Birgitta
LU
; Moseby-Knappe, Marion
LU
; Larsson, Mårten
LU
; Sjögren, Johan
LU
; Wierup, Per
LU
; Nozohoor, Shahab
LU
and Zindovic, Igor
LU
(2023)
In JTCVS Open
15.
p.38-60
- Abstract
Objective: The study objective was to assess the radiological properties of acute type A aortic dissection–related neurological injuries and identify predictors of neurological injury. Methods: Our single-center, retrospective, observational study included all patients who underwent acute type A aortic dissection repair between January 1998 and December 2021. Multivariable analyses and Cox regression were performed to identify predictors of embolic lesions, watershed lesions, neurological injury, 30-day mortality, and late mortality. Results: A total of 538 patients were included. Of these, 120 patients (22.3%) experienced postoperative neurological injury; 74 patients (13.8%) had postoperative stroke, and 36 patients (6.8%) had... (More)
Objective: The study objective was to assess the radiological properties of acute type A aortic dissection–related neurological injuries and identify predictors of neurological injury. Methods: Our single-center, retrospective, observational study included all patients who underwent acute type A aortic dissection repair between January 1998 and December 2021. Multivariable analyses and Cox regression were performed to identify predictors of embolic lesions, watershed lesions, neurological injury, 30-day mortality, and late mortality. Results: A total of 538 patients were included. Of these, 120 patients (22.3%) experienced postoperative neurological injury; 74 patients (13.8%) had postoperative stroke, and 36 patients (6.8%) had postoperative coma. The 30-day mortality was 22.7% in the neurological injury group versus 5.8% in the no neurological injury group (P < .001). We identified several independent predictors of neurological injury. Cerebral malperfusion (odds ratio, 2.77; 95% confidence interval, 1.53-5.00), systemic hypotensive shock (odds ratio, 1.97; 95% confidence interval, 1.13-3.43), and aortic arch replacement (odds ratio, 3.08; 95% confidence interval, 1.17-8.08) predicted embolic lesions. Diabetes mellitus (odds ratio, 5.35; 95% confidence interval, 1.85-15.42), previous cardiac surgery (odds ratio, 8.62; 95% confidence interval, 1.47-50.43), duration of hypothermic circulatory arrest (odds ratio, 1.05; 95% confidence interval, 1.01-1.08), cardiopulmonary bypass time (odds ratio, 1.01; 95% confidence interval, 1.00-1.01), ascending aortic/arch cannulation (odds ratio, 5.68; 95% confidence interval, 1.88-17.12), and left ventricular cannulation (odds ratio, 17.81; 95% confidence interval, 1.69-188.01) predicted watershed lesions. Retrograde cerebral perfusion (odds ratio, 0.28; 95% confidence interval, 0.01-0.84) had a protective effect against watershed lesions. Conclusions: In this study, we demonstrated that the radiological features of neurological injury may be as important as clinical characteristics in understanding the pathophysiology and causality behind neurological injury related to acute type A aortic dissection repair.
(Less)
- author
- Ede, Jacob
LU
; Teurneau-Hermansson, Karl
LU
; Ramgren, Birgitta
LU
; Moseby-Knappe, Marion
LU
; Larsson, Mårten
LU
; Sjögren, Johan
LU
; Wierup, Per
LU
; Nozohoor, Shahab
LU
and Zindovic, Igor
LU
- organization
-
- Neurological injury in acute type A aortic dissection (research group)
- Thoracic Surgery
- Clinical Sciences, Helsingborg
- Stroke Imaging Research group (research group)
- Neuroradiology (research group)
- Diagnostic Radiology, (Lund)
- Neurology, Lund
- Brain Injury After Cardiac Arrest (research group)
- Minimal invasive cardiac surgery in valvular heart disease (research group)
- Bleeding disorders and acute typ-A dissection (research group)
- Less invasive cardiac surgery (research group)
- DCD transplantation of lungs (research group)
- Heparin bindning protein in cardiothoracic surgery (research group)
- publishing date
- 2023-09
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- aorta, dissection, embolism, stroke, watershed lesions
- in
- JTCVS Open
- volume
- 15
- pages
- 23 pages
- publisher
- Elsevier
- external identifiers
-
- pmid:37808039
- scopus:85164518559
- ISSN
- 2666-2736
- DOI
- 10.1016/j.xjon.2023.06.005
- language
- English
- LU publication?
- yes
- id
- 930f61df-0cb4-4525-affe-81c9bcf96adc
- date added to LUP
- 2023-10-09 12:55:27
- date last changed
- 2024-04-19 02:08:48
@article{930f61df-0cb4-4525-affe-81c9bcf96adc,
abstract = {{<p>Objective: The study objective was to assess the radiological properties of acute type A aortic dissection–related neurological injuries and identify predictors of neurological injury. Methods: Our single-center, retrospective, observational study included all patients who underwent acute type A aortic dissection repair between January 1998 and December 2021. Multivariable analyses and Cox regression were performed to identify predictors of embolic lesions, watershed lesions, neurological injury, 30-day mortality, and late mortality. Results: A total of 538 patients were included. Of these, 120 patients (22.3%) experienced postoperative neurological injury; 74 patients (13.8%) had postoperative stroke, and 36 patients (6.8%) had postoperative coma. The 30-day mortality was 22.7% in the neurological injury group versus 5.8% in the no neurological injury group (P < .001). We identified several independent predictors of neurological injury. Cerebral malperfusion (odds ratio, 2.77; 95% confidence interval, 1.53-5.00), systemic hypotensive shock (odds ratio, 1.97; 95% confidence interval, 1.13-3.43), and aortic arch replacement (odds ratio, 3.08; 95% confidence interval, 1.17-8.08) predicted embolic lesions. Diabetes mellitus (odds ratio, 5.35; 95% confidence interval, 1.85-15.42), previous cardiac surgery (odds ratio, 8.62; 95% confidence interval, 1.47-50.43), duration of hypothermic circulatory arrest (odds ratio, 1.05; 95% confidence interval, 1.01-1.08), cardiopulmonary bypass time (odds ratio, 1.01; 95% confidence interval, 1.00-1.01), ascending aortic/arch cannulation (odds ratio, 5.68; 95% confidence interval, 1.88-17.12), and left ventricular cannulation (odds ratio, 17.81; 95% confidence interval, 1.69-188.01) predicted watershed lesions. Retrograde cerebral perfusion (odds ratio, 0.28; 95% confidence interval, 0.01-0.84) had a protective effect against watershed lesions. Conclusions: In this study, we demonstrated that the radiological features of neurological injury may be as important as clinical characteristics in understanding the pathophysiology and causality behind neurological injury related to acute type A aortic dissection repair.</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 = {{2666-2736}},
keywords = {{aorta; dissection; embolism; stroke; watershed lesions}},
language = {{eng}},
pages = {{38--60}},
publisher = {{Elsevier}},
series = {{JTCVS Open}},
title = {{Radiological properties of neurological injury following acute type A aortic dissection repair}},
url = {{http://dx.doi.org/10.1016/j.xjon.2023.06.005}},
doi = {{10.1016/j.xjon.2023.06.005}},
volume = {{15}},
year = {{2023}},
}