Outcomes following surgery for acute type A aortic dissection complicated by cerebral malperfusion based on the aortic-repair-first strategy

Abstract OBJECTIVES To assess in-hospital and late outcomes in acute type A aortic dissection (ATAAD) patients with cerebral malperfusion undergoing aortic repair without early reperfusion procedures. METHODS In this single-centre retrospective cohort study, the study population consisted of 378 patients undergoing surgery for ATAAD. Cerebral malperfusion was defined as the presence of (i) neurological symptoms due to dissected carotid arteries or (ii) collapsed true lumen due to compression by a thrombosed false lumen. RESULTS Cerebral malperfusion (CM) was diagnosed in 74 patients (20%) (CM group: N = 74 and non-CM group: N = 304). Operative mortality was 5.4% in the CM group and 4.6% in the non-CM group (P > 0.99). The incidence of perioperative stroke was significantly higher in the CM group than in the non-CM group (27% versus 5.3%, P < 0.001). Among patients in the CM group, the incidence of perioperative stroke was 9/41 (22%) in patients without preoperative symptoms, 1/13 (7.7%) with transient symptoms, and 10/20 (50%) with persistent symptoms (P = 0.015). With a median follow-up of 2.1 (interquartile range: 0.8–5.3) years after surgery, the cumulative 5-year incidence of all-cause death was 17.4% in the CM group and 13.7% in the non-CM group (Log-rank P = 0.75). After adjusting for confounders, there was no excess risk of the CM group relative to the non-CM group for all-cause death (adjusted hazard ratio, 1.01; 95% confidence interval, 0.52–1.95; P = 0.99). CONCLUSIONS In-hospital and late risks for mortality were similar between patients with and without cerebral malperfusion following the aortic-repair-first strategy for ATAAD, despite the higher incidence of perioperative stroke in patients with cerebral malperfusion.