Cho Tomoki, Uchida Keiji, Kasama Keiichiro, Machida Daisuke, Minami Tomoyuki, Yasuda Shota, Matsuki Yusuke, Suzuki Shinichi, Masuda Munetaka
Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
Department of Surgery, Yokohama City University, Yokohama, Japan.
J Card Surg. 2021 Mar;36(3):902-908. doi: 10.1111/jocs.15322. Epub 2021 Jan 13.
Postoperative stroke is a serious unsolved complication after acute type A aortic dissection (ATAAD) repair. We investigated the incidence and risk factors of stroke, and hypothesized that dissection of supra-aortic vessels is an important risk factor of this morbidity.
Between 2012 and 2019, 202 (56% men, median age 68 years) patients with ATAAD underwent surgical repair. Clinical data, image findings, method of circulatory support, and repair technique were retrospectively investigated to explore the risk factor of postoperative stroke.
Of the 202 patients, operative mortality was 6% and the incidence of postoperative stroke was 12% (n = 25). Brachiocephalic artery (BCA) dissection was associated with a higher risk of stroke (odds ratio, 3.89; 95% confidence interval, 1.104-13.780; p = .035) having no relation to the presence or absence of left common carotid artery dissection. Preoperative malperfusion syndrome, circulatory arrest time, isolated cerebral perfusion time, repair technique (total arch replacement), and femoral artery perfusion alone were not related to the incident rate of postoperative stroke. Stroke occurred in both hemispheres, regardless of the laterality of carotid artery dissection.
BCA dissection was an independent risk factor of stroke after ATAAD repair.
术后卒中是急性A型主动脉夹层（ATAAD）修复术后一种严重且尚未解决的并发症。我们调查了卒中的发生率和危险因素，并假设主动脉弓上血管夹层是该并发症的一个重要危险因素。
2012年至2019年间，202例（56%为男性，中位年龄68岁）ATAAD患者接受了手术修复。对临床资料、影像检查结果、循环支持方法和修复技术进行回顾性研究，以探讨术后卒中的危险因素。
202例患者中，手术死亡率为6%，术后卒中发生率为12%（n = 25）。头臂动脉（BCA）夹层与较高的卒中风险相关（比值比，3.89；95%置信区间，1.104 - 13.780；p = 0.035），与左颈总动脉夹层的有无无关。术前灌注不良综合征、循环停止时间、单纯脑灌注时间、修复技术（全弓置换）和单纯股动脉灌注与术后卒中发生率无关。无论颈动脉夹层的侧别如何，双侧半球均发生了卒中。
BCA夹层是ATAAD修复术后卒中的独立危险因素。
