Neurological outcome following acute type A aortic dissection repair in the era of selective cerebral perfusion

BACKGROUND: The aim of this study was to identify predictors for permanent and transient neurologic deficits after acute type A aortic dissection repair using antegrade selective cerebral perfusion. METHODS: We performed a retrospective analysis of 167 patients (mean age 62.7 +/- 13.2 years, 68.3% male) treated for acute type A aortic dissection with hypothermic circulatory arrest and cerebral perfusion at out institution between 2003 and 2020. Bi-hemispheric antegrade selective cerebral perfusion was used in all patients. Among them, 65 (38.9%) also underwent a short phase of retrograde cerebral perfusion. RESULTS: Overall, 19.8% of the patients died in-hospital, 8.4% during surgery and 11.4% during the postoperative course. Permanent neurologic deficits occurred in 9% of the patients, whereas, in 4.2% of the cases the deficits were transient. Among patients who underwent antegrade selective cerebral perfusion alone and those who underwent also retrograde cerebral perfusion, the rate of permanent neurologic deficits was 13.3% and 3.1% (P=0.02), respectively. At multivariate analysis, chronic renal failure was found to be an independent risk factor for permanent neurologic deficits (odds ratio 9.86; P=0.003). Conversely, retrograde cerebral perfusion (in addition to antegrade cerebral perfusion) turned out to be a protective independent factor for permanent neurologic deficits (odds ratio 0.18; P=0.04). CONCLUSIONS: Early surgical results were favorable with a relatively low operative and in-hospital mortality and low rates of permanent and transient neurologic deficits. A short phase of retrograde cerebral perfusion turned out to be a strong protective independent factor for permanent neurologic deficits.