title: Emergency operation for acute type A aortic dissection: neurologic complications and early mortality.
abstract: BACKGROUND
  Acute type A aortic dissection is a surgical emergency still associated with high postoperative complications. The aim of this study was to investigate factors for hospital mortality and neurologic deficit in patients undergoing emergency operation for acute type A aortic dissection.
  
  
  METHODS
  Eighty-five consecutive patients (age range, 20 to 82 years) operated on for acute type A aortic dissection over a 6-year period were evaluated. Univariate and stepwise multiple logistic regression analyses were conducted among 32 perioperative variables.
  
  
  RESULTS
  All patients underwent surgical procedures under deep hypothermic circulatory arrest. Antegrade or retrograde cerebral perfusion was used in 23 patients (27.1%) and 18 patients (21.2%), respectively. Forty-three patients underwent arch/hemiarch replacement and the ascending aorta was replaced in 42 patients. Overall mortality rate was 25.9% (22 of 85 patients). Multiple logistic regression analysis showed that lack of cerebral perfusion (p = 0.021) and postoperative renal failure (p = 0.006) were the best predictors for hospital death. Twenty-one patients (24.7%) experienced neurologic accidents. The risk factor for postoperative neurologic complication was lack of cerebral perfusion (p = 0.013). Hospital mortality was 13% (3 of 23 patients) and 16.7% (3 of 18 patients) in the antegrade and retrograde cerebral perfusion groups (p > 0.05) and neurologic deficit was 13% (3 of 23 patients) and 11.1% (2 of 18 patients), respectively (p > 0.05).
  
  
  CONCLUSIONS
  Hospital mortality and neurologic complications in patients undergoing emergent operation for acute type A aortic dissection were reduced when cerebral perfusion was used with deep hypothermic circulatory arrest.
authors.affiliation: Department of Cardiac Surgery, University of Rome La Sapienza, Italy. rsinatra@uniroma1.it
authors.forename: R
authors.initials: R
authors.lastname: Sinatra
authors.forename: G
authors.initials: G
authors.lastname: Melina
authors.forename: I
authors.initials: I
authors.lastname: Pulitani
authors.forename: B
authors.initials: B
authors.lastname: Fiorani
authors.forename: G
authors.initials: G
authors.lastname: Ruvolo
authors.forename: B
authors.initials: B
authors.lastname: Marino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001921:Brain / Q000098:blood supply; D003072:Cognition Disorders / Q000209:etiology; D004632:Emergency Medical Services; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged