Risk Factors for Permanent Neurological Dysfunction and Early Mortality in Patients with Type A Aortic Dissection Requiring Total Arch Replacement

Abstract

Background: Surgery is a definitive treatment for patients with type A aortic dissection. The aim of this study was to identify and analyze the risk factors for permanent neurological dysfunction (PND) and 30-day mortality in patients following total arch replacement and stented elephant trunk implantation in the descending aorta. Methods: The clinical data of 85 consecutive patients who underwent this surgical procedure between December 2013 and May 2017 were reviewed. Multivariate logistic regression analysis was performed to determine the independent predictors of postoperative PND and 30-day mortality. Results: There were 62 males and 23 females, with a mean age of 47.6 ± 11.7 years (range, 26-73 years). Ten patients (11.76%) developed PND after surgery. Postoperative 30-day mortality was 11.76% (10/85), including one death during hospitalization and nine deaths after discharge. Multivariate analysis showed that hypertension was independently associated with postoperative PND (OR = 4.407, 95% CI: 1.021-19.023, P = .047), and age and postoperative PND were independent predictors for 30-day mortality (OR, 1.120; 95% CI, 1.026-1.221; P = .011 and OR, 7.503; CI, 1.290-43.634; P = .025, respectively). Conclusion: Hypertension was independently associated with postoperative PND, and age and postoperative PND were predictors for early mortality in patients who underwent total arch replacement and stented elephant trunk implantation.