A Study on Outcome in Stanford Type A Aortic Dissection Focusing on Neurological Outcome and New Surgical Techniques


Background: Surgical repair of aortic type A dissections is now standard practise, yet despite decades of technological advancements, some problems persist. The most serious side effects are neurological impairments, which have been measured at a rate of up to 25% in worldwide studies. We focused on the postoperative outcome after surgical correction of type A dissections over a ten-year period in this study. Specific problems, neurological outcomes, and technical advancements with modern surgical procedures, including cannulation strategy, have all received special attention. Methods: A retrospective analysis with a 10-year follow-up was performed on a cohort of 147 patients who had surgery since 2004. The Cox-proportional hazard model was used to analyse the data, which included more than 30 factors. The survival rate after 1 year (5, 10 years) was 98 percent (88 percent , 50 percent ). In recent years, the early death rate for all patients has dropped to 14%. Females comprised 27 percent of the population, and they were older than men (+10 years on average, 64+10 years). Gender has no bearing on survival. For the first postoperative year, the survival probability (Log rank test) was 0.82/0.77 (male/female), 0.70/0.71 for 5 years, and 0.46/ 0.50 for 10 years. The carotid arteries were clogged in 25% of patients prior to surgery. Neurological impairments were detected in 11% of patients prior to surgery. One-third (33%) of those might be reversed. Major and mild neurological impairments were observed in 22% of all patients after surgery. The occurrence of postoperative problems could be minimised with time (from nearly 27 percent to 10 percent ). When compared to all other cannulation sites, vascular access using truncal cannulation technique had a significantly lower risk (p=0.0168). Conclusions: Neurological problems, whether reversible preoperative impairments or postoperative new issues, could be reduced. Neurological problems accompanied with carotid occlusions should prompt doctors to take a more thorough diagnostic approach, including looking at the supraaortic/brachiocephalic branches of the aorta. We could obtain a 50% reduction in postoperative neurological deficits from nearly 20% to under 10%, as well as a 50% reduction in death rates from nearly 30% to around 15%, by making technical improvements and surgical advancements. A growing number of long-term survivors attest to this. Adopting contemporary perfusion techniques aids in the recovery of rheumatoid arthritis.

Author (s) Details

Frank Harig
Department of Cardiac Surgery, University Hospital Erlangen, Nuremberg, Erlangen, Germany.

Anna Engel
Department of Cardiology and Angiology, University Hospital Erlangen, Nuremberg, Erlangen, Germany.

Johannes Rösch
Department of Cardiac Surgery, University Hospital Erlangen, Nuremberg, Erlangen, Germany.

Michael Weyand
Department of Cardiac Surgery, University Hospital Erlangen, Nuremberg, Erlangen, Germany.

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