Analysis of risk factors for neurological dysfunction in patients with acute aortic dissection type A: Data from the German registry for acute aortic dissection type A (GERAADA)

Objectives: Acute aortic dissection type A (AADA) is associated with major adverse events, such as transient or persistent neurological dysfunction (ND), which may be patient-, disease- or surgery-related. There is a lack of consensus regarding risk factors for ND in AADA patients. The aim of this study was to analyse and identify risk factors for new postoperative ND after aortic repair for AADA. Methods: Between July 2006 and June 2010, 2137 AADA patients were enrolled in the multi-centre, prospective German Registry of AADA (GERAADA). Perioperative data were prospectively gathered from 50 institutes in Austria, Switzerland and Germany, and multivariate logistic regression analysis was performed to determine the independent predictors of new onset ND. Results: ND occurred in 20.3% of all patients prior to surgery, 12.6% of which resolved postoperatively and 7.7% persisted. New ND after AADA surgery occurred in 9.5% of patients. Risk factors for an increased rate of postoperative new ND were malperfusion syndrome of three or more territories prior to surgery [odds ratio (OR) = 2.206, P = 0.0065], dissection of the supraaortic vessels (OR = 1.468, P = 0.0103) and longer operating time (OR = 1.002 per min, P = 0.0001). New postoperative ND was associated with an increased rate of mortality (22.5 vs. 16.1%, P = 0.0087). Arterial cannulation site had no statistically significant impact on neurological outcomes. Conclusions: Neurological complications are associated with increased mortality post-AADA repair. New onset ND is associated with extensive malperfusion syndrome, supraaortic vessel dissection and operative time and does not seem to be affected by choice of arterial cannulation site.