title: Intraoperative neuroprotective drugs without beneficial effects? Results of the German Registry for Acute Aortic Dissection Type A (GERAADA).
abstract: OBJECTIVE
  Cerebral protection during acute aortic dissection Type A (AADA) surgery may be affected by perfusion strategies and ischaemic protective drugs.
  
  
  METHODS
  We analysed the impact of intraoperative barbiturate, steroid and mannitol use and adjunctive cerebral perfusion (CP), on 30-day mortality and new postoperative mortality-corrected permanent neurological dysfunction (PNDmc) in the German Registry for Acute Aortic Dissection Type A.
  
  
  RESULTS
  Two thousand one hundred and thirty-seven AADA patients were registered over a 4-year period. The overall 30-day mortality was 16.9%, and the overall rate of PNDmc was 10.0%. A total of 48% of patients received no neuroprotective drugs (control group), steroid monotherapy was used in 11.2% of patients, barbiturates in 8.4%, mannitol in 7.3% and the remainder (25.1%) received a combination of these drugs. The PNDmc rate was 10.6% in the control group and lower (7.1%) in the steroid group (adjusted odds ratio [OR] 0.50; 95% confidence interval [95% CI] 0.24-0.96; P = 0.049). No PNDmc reduction was observed for mannitol or barbiturates. Thirty-day mortality was 18.7% in the control group and with 8.9% lower (P = 0.003) in the mannitol group (adjusted OR 0.58; 95% CI 0.19-1.49; P = 0.295). Hypothermic circulatory arrest that exceeded 30 min was associated with an increased 30-day mortality rate (31.4%) compared with patients who received adjunctive CP >30 min during aortic arch intervention (21.4%) (P = 0.04). We were unable to demonstrate a significant protective effect of any neuroprotective drug on 30-day mortality, or PNDmc rates during prolonged (≥30 min) cerebral ischaemia.
  
  
  CONCLUSIONS
  Mannitol may be associated with decreased mortality in patients undergoing AADA surgery. Steroid administration may be associated with improved neurological outcomes, but more investigation is required.
authors: Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany.
authors: Tobias
authors: T
authors: Krüger
authors: Isabell
authors: I
authors: Hoffmann
authors: Maria
authors: M
authors: Blettner
authors: Michael Andrew
authors: MA
authors: Borger
authors: Christian
authors: C
authors: Schlensak
authors: Ernst
authors: E
authors: Weigang
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000453:epidemiology / Q000601:surgery*; D001463:Barbiturates / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D008875:Middle Aged; D009026:Mortality; D018696:Neuroprotective Agents / Q000008:administration & dosage*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage
chemical_list: D001463:Barbiturates; D018696:Neuroprotective Agents; D013256:Steroids; D008353:Mannitol; C032232:barbituric acid
keywords: Aortic dissection; Aortic operation; Cerebral protection; Neurology/Neurological; Pharmacology; Registry; The German Registry for Acute Aortic Dissection Type A