Risk factors for neurological dysfunctions after surgical repair of acute aortic dissection type A

Abstract

Introduction: Technical improvement and new operative strategies significantly influence survival and outcomes after the treatment of acute aortic dissection type A (AADA). However, postoperative complications and particularly neurological dysfunctions (ND) are still very common. Aim: To identify preoperative and intraoperative factors as well as immediate postoperative conditions with an influence on the occurrence of neurological complications of surgical treatment of AADA and accordingly take action to reduce them. Material and methods: Between January 2013 and December 2018, 240 patients with AADA were emergently surgically treated. All patients were divided into two groups: group I-patients with postoperative ND (subgroup Ia-patients with mild, transient ND and Ib-patients with severe ND) and group II-patients without ND. Results: Neurological damage after the operation was registered in 87 (39.5%) patients. Thirty (13.6%) patients had mild ND and 57 (25.9%) severe. Presence of preoperative neurological deficit, reduced level of consciousness, supra-aortic vessel dissection, hemodynamic instability, and excessive postoperative bleeding with hypotension are factors with a highly statistically significant association with the occurrence of severe ND. Neurological complications were not identified in 66.7% of patients who were axillary cannulated versus 55.9% of patients cannulated in the other way but the difference did not reach statistical significance (p = 0.1099). Conclusions: Advanced neuroprotective strategies during surgical treatment of AADA are associated with favorable neurological outcomes, especially in a group of patients with identified risk factors for ND.

A comparison of single and double arterial cannulation for cardiopulmonary bypass for acute type A aortic surgery: A single center, retrospective observational study

“…1 In spite of the fact that there are various techniques for cannulation in the intraoperative setting according to the patient's condition and surgeon preferences, it is very important to select an appropriate arterial cannulation that not only ensures massive organ perfusion, but also avoids the risk of malperfusion during cardiopulmonary bypass (CPB). 2 The time to establish CPB, the deterioration of dissection through the cannulation, and the malperfusion after the start of CPB are all factors to consider must be taken into account when selecting the cannulation site. 3 The femoral artery and axillary artery are the most commonly used arterial cannulation sites.…”

“…1 In spite of the fact that there are various techniques for cannulation in the intraoperative setting according to the patient’s condition and surgeon preferences, it is very important to select an appropriate arterial cannulation that not only ensures massive organ perfusion, but also avoids the risk of malperfusion during cardiopulmonary bypass (CPB). 2…”