title: Bovine aortic arch: predictor of entry site and risk factor for neurologic injury in acute type a dissection.
abstract: BACKGROUND
  The aim of this study was to evaluate if the presence of a bovine aortic arch (BAA)- the most common aortic arch anomaly-influences the location of the primary entry tear, the surgical procedure, and the outcome of patients undergoing operation for type A acute aortic dissection (AAD).
  
  
  METHODS
  A total of 157 patients underwent emergency operations because of AAD (71% men, mean age 59.5 ± 13 years). Preoperative computed tomographic scans were screened for the presence of BAA. Patients were separated into 2 groups: presenting with BAA (BAA+, n = 22) or not (BAA-, n = 135). Location of the primary tear, surgical treatment, outcome, and risk factors for postoperative neurologic injury and in-hospital mortality were analyzed.
  
  
  RESULTS
  Fourteen percent (22 of 157) of all patients operated on for AAD had a concomitant BAA. Location of the primary entry tear was predominantly in the aortic arch in patients with BAA (BAA+, 59.1% versus BAA-, 13.3%; p < 0.001). Multivariate analysis revealed the presence of a BAA to be an independent risk factor for having the primary tear in the aortic arch (odds ratio [OR], 14.79; 95% confidence interval [CI] 4.54-48.13; p < 0.001) but not for in-hospital mortality. Patients with BAA had a higher rate of postoperative neurologic injury (BAA+, 35% versus BAA-, 7.9%; p = 0.004). Multivariate analysis identified the presence of BAA as an independent risk factor for postoperative neurologic injury (OR, 4.9; 95% CI, 1.635-14.734; p = 0.005).
  
  
  CONCLUSIONS
  In type A AAD, the presence of a BAA predicts the location of the primary entry site in the aortic arch and is an independent risk factor for a poor neurologic outcome.
authors.affiliation: Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria. Electronic address: julia.dumfarth@i-med.ac.at.
authors.forename: Julia
authors.initials: J
authors.lastname: Dumfarth
authors.affiliation: Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Michaela
authors.initials: M
authors.lastname: Plaikner
authors.affiliation: Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Krapf
authors.affiliation: Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bonaros
authors.affiliation: Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Severin
authors.initials: S
authors.lastname: Semsroth
authors.affiliation: Division of Occupational, Environmental, and Clinical Preventive Medicine, Stony Brooke University, Stony Brooke, New York.
authors.forename: John A
authors.initials: JA
authors.lastname: Rizzo
authors.affiliation: Department of Health Systems, Management, and Policy, University of Colorado, Denver, Colorado.
authors.forename: Hai
authors.initials: H
authors.lastname: Fang
authors.affiliation: Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.affiliation: Aortic Institute, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: John A
authors.initials: JA
authors.lastname: Elefteriades
authors.affiliation: Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachner
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000209:etiology* / Q000601:surgery; D001013:Aorta, Thoracic / Q000002:abnormalities*; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology* / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors