Immediate surgery in acute type A dissection and neurologic dysfunction: Fighting the inevitable?

Abstract Background Neurologic dysfunction remains an ongoing challenge in the diagnosis of type A aortic dissection (AAD). Purpose of our study was to analyse the impact of preoperative neurologic dysfunction (PND) on outcome and to assess a potential link between PND and specific patterns of postoperative neurologic injury. Methods Medical records of 338 patients (70.1% male, mean age 59.3±13.7 years) undergoing surgery for AAD were screened for presence of PND. Preoperative characteristics, surgical treatment, hospital and neurologic outcome were analysed according to patients’ preoperative neurologic status (PND+ for patients with PND, PND- for patients with normal neurologic status). Results In total, 50 patients (14.8%) were admitted with PND. Patients with PND showed significantly higher rates of postoperative neurologic injury (44.4% in PND+ versus 14.3% in PND- patients, p Conclusions This study identified an association of preoperative neurologic status and specific stroke patterns after surgical repair of AAD. Irrespectively of timing of surgery and reperfusion strategies, preoperative neurologic dysfunction is strongly associated with impaired neurological outcome.