Abstract 12594: Impact of Surgical Stroke on Early and Late Outcomes After Thoracic Aortic Surgery
Introduction: Despite recent improvements in surgical technique and cerebral protection methods, surgical thoracic aortic repair is still an invasive procedure with a substantial rate of mortality and neurologic injury. The aim of this study is to investigate the impact of surgical stroke on early and late outcomes including ADL and QOL as well as mortality after thoracic aortic surgery.
Methods: We retrospectively analyzed consecutive 500 cases (male: 350, mean age: 62.9±13.2 years) of open aortic repair from 1986 to 2008 performed in our institute. Urgent status was 20.6%. Type of aneurysm was atherosclerotic in 68%, dissected in 32%. Replacement segment was root and ascending (31%), arch (39%), extended arch (10%), descending and its distal (19%). Brain protection method was retrograde cerebral perfusion (RCP) (58%), antegrade cerebral perfusion (ACP) (26%), deep hypothermic circulatory arrest (DHCA) (16%). Surgical stroke was defined as neurological deficit persist over 72 hours after surgery. We analyzed survival rate by Kaplan-Meier method, long term QOL by SF36 and risk factor of late death by Cox proportional hazards model.
Results: Stroke rate was 10.3%. Hospital mortality of stroke group was 21%, whereas non-stroke group was 2.7% (P≤0.001). Seventy-six % of survivor in stroke group revealed permanent neurological deficit (PND) at discharge, whose status at discharge was tracheostomy in 30%, tube feeding in 38%, gastrostomy in 11% and transfer to other facilities in 80%. Survival rate at 5 and 10 years was significantly lower in PND group (65%, 31%) than non-stroke group (86%, 76%) and temporary neurological dysfunction group (86%, 57%) (P≤0.001). PND was significant risk factor of late death (P≤0.001, OR2.781, 95%CI1.618-4.778) in univariate analysis, but not significant in multivariate analysis. In the QOL analysis, physical component was worse in PND group (51% vs 100% P=0.051), whereas mental component was similar in both group (14% vs 14%) .
Conclusion: Surgical stroke leads to high hospital mortality and permanent neurological deficit that makes late survival worse. Even they survive, physical component of QOL remains deteriorated.
- © 2013 by American Heart Association, Inc.