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Risk factors for impaired neurological outcome after thoracic aortic surgery
BACKGROUND: We aimed to identify risk factors for an impaired postoperative neurological outcome after thoracic aortic surgery. METHODS: Data from all patients undergoing thoracic aortic surgery between 2010 and 2020 at our institution were collected and analyzed retrospectively. Logistic regression...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9264055/ https://www.ncbi.nlm.nih.gov/pubmed/35813705 http://dx.doi.org/10.21037/jtd-21-1591 |
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author | Demal, Till J. Sitzmann, Franziska W. Bax, Lennart von Kodolitsch, Yskert Brickwedel, Jens Konertz, Johanna Gaekel, Daniel M. Sadeq, Ahmed J. Kölbel, Tilo Vettorazzi, Eik Reichenspurner, Hermann Detter, Christian |
author_facet | Demal, Till J. Sitzmann, Franziska W. Bax, Lennart von Kodolitsch, Yskert Brickwedel, Jens Konertz, Johanna Gaekel, Daniel M. Sadeq, Ahmed J. Kölbel, Tilo Vettorazzi, Eik Reichenspurner, Hermann Detter, Christian |
author_sort | Demal, Till J. |
collection | PubMed |
description | BACKGROUND: We aimed to identify risk factors for an impaired postoperative neurological outcome after thoracic aortic surgery. METHODS: Data from all patients undergoing thoracic aortic surgery between 2010 and 2020 at our institution were collected and analyzed retrospectively. Logistic regression analysis was used to identify independent risk factors for permanent postoperative neurological deficit (ND) (stroke), which was defined as a ND lasting at least seven days. RESULTS: Thoracic aortic surgery was performed in 1,334 patients. Of these, 286 (21.4%) underwent emergency surgery. The mean EuroSCORE II was 8.6±10.1. A perioperative stroke occurred in 94 patients (7.0%). Of all strokes, 62.8% (n=59) were considered of embolic and 24.5% (n=23) of hemodynamic origin. In elective procedures, stroke rates ranged from 0.5% after valve-sparing root replacement to 8.1% after arch surgery. Adjusted logistic regression identified advanced age [>70 years; odds ratio (OR), 1.83; P=0.009], acute type A dissection (ATAD) (OR, 1.69; P=0.0495), aortic arch surgery (OR, 3.24; P<0.001), concomitant coronary artery bypass grafting (CABG) (OR, 2.19; P=0.005), and high extracorporeal circulation (ECC) time (>230 min; OR, 1.70; P=0.034) as independent risk factors for all strokes. Secondary endpoint analyses revealed that risk factors for hemodynamic stroke were arch surgery, advanced age (>70 years), atherosclerosis, and ATAD. Risk factors for embolic stroke were arch surgery, concomitant CABG and preoperative cerebral malperfusion. CONCLUSIONS: Identified independent risk factors for all strokes were advanced age, ATAD, arch surgery, concomitant CABG, and high ECC time. Hemodynamic and embolic strokes show distinct risk profiles. |
format | Online Article Text |
id | pubmed-9264055 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-92640552022-07-09 Risk factors for impaired neurological outcome after thoracic aortic surgery Demal, Till J. Sitzmann, Franziska W. Bax, Lennart von Kodolitsch, Yskert Brickwedel, Jens Konertz, Johanna Gaekel, Daniel M. Sadeq, Ahmed J. Kölbel, Tilo Vettorazzi, Eik Reichenspurner, Hermann Detter, Christian J Thorac Dis Original Article BACKGROUND: We aimed to identify risk factors for an impaired postoperative neurological outcome after thoracic aortic surgery. METHODS: Data from all patients undergoing thoracic aortic surgery between 2010 and 2020 at our institution were collected and analyzed retrospectively. Logistic regression analysis was used to identify independent risk factors for permanent postoperative neurological deficit (ND) (stroke), which was defined as a ND lasting at least seven days. RESULTS: Thoracic aortic surgery was performed in 1,334 patients. Of these, 286 (21.4%) underwent emergency surgery. The mean EuroSCORE II was 8.6±10.1. A perioperative stroke occurred in 94 patients (7.0%). Of all strokes, 62.8% (n=59) were considered of embolic and 24.5% (n=23) of hemodynamic origin. In elective procedures, stroke rates ranged from 0.5% after valve-sparing root replacement to 8.1% after arch surgery. Adjusted logistic regression identified advanced age [>70 years; odds ratio (OR), 1.83; P=0.009], acute type A dissection (ATAD) (OR, 1.69; P=0.0495), aortic arch surgery (OR, 3.24; P<0.001), concomitant coronary artery bypass grafting (CABG) (OR, 2.19; P=0.005), and high extracorporeal circulation (ECC) time (>230 min; OR, 1.70; P=0.034) as independent risk factors for all strokes. Secondary endpoint analyses revealed that risk factors for hemodynamic stroke were arch surgery, advanced age (>70 years), atherosclerosis, and ATAD. Risk factors for embolic stroke were arch surgery, concomitant CABG and preoperative cerebral malperfusion. CONCLUSIONS: Identified independent risk factors for all strokes were advanced age, ATAD, arch surgery, concomitant CABG, and high ECC time. Hemodynamic and embolic strokes show distinct risk profiles. AME Publishing Company 2022-06 /pmc/articles/PMC9264055/ /pubmed/35813705 http://dx.doi.org/10.21037/jtd-21-1591 Text en 2022 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Demal, Till J. Sitzmann, Franziska W. Bax, Lennart von Kodolitsch, Yskert Brickwedel, Jens Konertz, Johanna Gaekel, Daniel M. Sadeq, Ahmed J. Kölbel, Tilo Vettorazzi, Eik Reichenspurner, Hermann Detter, Christian Risk factors for impaired neurological outcome after thoracic aortic surgery |
title | Risk factors for impaired neurological outcome after thoracic aortic surgery |
title_full | Risk factors for impaired neurological outcome after thoracic aortic surgery |
title_fullStr | Risk factors for impaired neurological outcome after thoracic aortic surgery |
title_full_unstemmed | Risk factors for impaired neurological outcome after thoracic aortic surgery |
title_short | Risk factors for impaired neurological outcome after thoracic aortic surgery |
title_sort | risk factors for impaired neurological outcome after thoracic aortic surgery |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9264055/ https://www.ncbi.nlm.nih.gov/pubmed/35813705 http://dx.doi.org/10.21037/jtd-21-1591 |
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