Abstract
Background We hypothesized that preoperative computed tomography (CT) is a predictor of abdominal
intervention for visceral malperfusion and stroke after emergent surgery for acute
type A aortic dissection (AAAD).
Methods A total of 90 patients, mean (± SD [standard deviation]) age 62 (± 12) years, 76%
males, undergoing emergent surgery for AAAD at our institution from May 2008 to August
2013 were included. All clinical data were collected prospectively and correlated
to CT images.
Results At initial presentation 9 (10%) patients showed preoperative focal neurologic deficit
or coma, 10 patients (11%) complained of abdominal pain, and the logistic EuroSCORE
was 44 (± 22). Hemiarch replacement was performed in 96%, total arch in 4%. The duration
of hypothermic circulatory arrest (HCA) at 28°C bladder temperature was 26 (± 19)
minutes. Cross-clamp time was 88 (± 39) minutes, and cardiopulmonary bypass (CPB)
time 148 (± 49) minutes. Overall 30-day mortality was 13%. Moreover, 12 (13%) patients
required postoperative abdominal interventions for suspected visceral malperfusion;
stroke occurred in 25 (28%) patients. Logistic regression revealed that “dissection
of the celiac trunk and/or the superior mesenteric artery” in preoperative CT images
is a predictor of postoperative abdominal interventions for visceral malperfusion
(p = 0.03), but preoperative abdominal pain is not similarly predictive. Postoperative
stroke is best predicted by preoperative neurologic symptoms (p = 0.01), but not by supra-aortic vessel dissection in preoperative CT images.
Conclusion In patients undergoing surgery for AAAD, analysis of preoperative CT images allows
identifying those with a high risk of postoperative abdominal intervention for visceral
malperfusion. Postoperative stroke is best predicted by preoperative neurologic symptoms.
Keywords
aorta/aortic - hypothermia/circulatory arrest - imaging
