CEREBROVASCULAR ACCIDENTS AFTER AORTIC ROOT REPLACEMENT FOR ASCENDING AORTIC ANEURYSM

Objective: Cerebrovascular accidents (CVAs) are an important and widespread problem after cardiac surgery. Although different risk factors behind CVAs after thoracic aortic surgery have been identified, several of them have been confounded by patient selection, including type of aortic surgery, deep hypothermic circulatory arrest employment or emergency procedures. In a multicenter study we attempted to study the predictors of CVAs in patients undergoing aortic root replacement (ARR). Methods: Data from 408 patients operated on ARR for ascending aortic aneurysms were obtained from a multicenter registry over a 10-year period. All patients were screened for CVAs, with reference to possible predictors and impact on clinical outcome. Results: The studied population had an average age of 62±12 years and contained 79% men. Postoperative CVAs developed in 18 patients (4.4%): stroke occurred in five patients (1.3%), transient ischemic attack in 10 (2.5%), and delirium in seven cases (1.7%). Independent CVA predictors were postoperative cardiac failure (OR 6.61; 95% CI 1.55–28.26), body mass index (BMI; OR 1.15; 95% CI 1.02-1-29), and postoperative acute kidney injury (AKI) defined by RIFLE criteria (OR 3.19; 95% CI 1.15–8.86). Age, deep hypothermic circulatory arrest, or associated aortic arch surgery were not independent CVA predictors. Postoperative CVAs were also associated with hospital mortality (OR 54.12; 95% CI 1.28–93.28). Conclusions: In this multicenter study, postoperative cardiac failure, BMI, and AKI appeared as novel and independent predictors of CVAs. These results provided new data insight on CVA occurrence after ARR for ascending aorta aneurysms.