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Eur J Cardiothorac Surg 2005;28:473-477
© 2005 Elsevier Science NL

Original articles

Multivariate analysis of predictors of late stroke after total aortic arch repair

Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan

Received 28 March 2005; received in revised form 16 May 2005; accepted 18 May 2005.

^* Corresponding author. Tel.: +81 668 33 5012; fax: +81 668 72 7486. (Email: hogino{at}hsp.ncvc.go.jp).

Abstract

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.

Key Words: Aorta • Surgery • Stroke • Complication

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