Multivariate analysis of predictors of late stroke after total aortic arch repair.
OBJECTIVE
The number of aortic surgeries has recently increased, with improvement of outcome due to the development of various novel operative techniques and adjuncts. Although the postoperative incidence of stroke, the most severe complication of aortic surgery, is still a matter of concern and has been described well previously, late stroke after aortic arch repair has not been described well. We assessed the incidence and predictors of late stroke after total aortic arch repair.


METHODS
From January 1993 to December 2003, 470 patients underwent total aortic arch repair in our institution. All patients, whether undergoing elective, urgent, or emergent aortic arch repair, were included. Emergent operation was required for 115 patients because of rupture or acute type A dissection. For brain protection, retrograde cerebral perfusion was used in 27% (125) and selective cerebral perfusion in 75% (353) of cases. The follow-up period was 32.5+/-31.5 months. Late stroke was defined as stroke occurring more than 30 days postoperatively.


RESULTS
The incidence of early postoperative stroke was 4.9% (23/470), while that of late postoperative stroke was 6.0% (28/470). On univariate analysis, postoperative atrial fibrillation (P=0.014), preoperative prevalence of craniocervical lesions (P=0.0001), and advanced age (P=0.046) were each significantly related to late stroke. A Cox proportional hazards model detected postoperative atrial fibrillation (P=0.013, OR=3.02, 95% CI: 1.26-7.24) and preoperative prevalence of craniocervical lesions (P=0.0001, OR=5.37, 95% CI: 2.30-12.52) as predictors of late stroke.


CONCLUSIONS
Postoperative atrial fibrillation and preoperative prevalence of craniocervical lesions were found to be risk factors for late stroke after total aortic arch repair.
Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
Kaoru
K
Matsuura
Hitoshi
H
Ogino
Hitoshi
H
Matsuda
Kenji
K
Minatoya
Hiroaki
H
Sasaki
Toshikatsu
T
Yagihara
Soichiro
S
Kitamura
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery; D001281:Atrial Fibrillation / Q000150:complications; D002561:Cerebrovascular Disorders / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D013997:Time Factors