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Brachiocephalic artery dissection is a marker of stroke after acute type A aortic dissection repair
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  • Tomoki Cho,
  • Keiji Uchida,
  • Keiichiro Kasama,
  • Daisuke Machida,
  • Tomoyuki Minami,
  • Shota Yasuda,
  • Yusuke Matsuki,
  • Shinichi Suzuki,
  • Munetaka Masuda
Tomoki Cho
Yokohama City University Medical Center
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Keiji Uchida
Yokohama City University Medical Center
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Keiichiro Kasama
Yokohama City University Medical Center
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Daisuke Machida
Yokohama City University
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Tomoyuki Minami
Yokohama City University Medical Center
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Shota Yasuda
Yokohama City University Medical Center
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Yusuke Matsuki
Yokohama City University Medical Center
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Shinichi Suzuki
Yokohama City University
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Munetaka Masuda
Yokohama City University
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Abstract

OBJECTIVE Postoperative stroke is a serious unsolved complication after acute type A aortic dissection repair. We investigated the incidence and risk factors of stroke and hypothesized that dissection of supra-aortic vessels is an important risk factor of this morbidity. METHODS Between 2012 and 2019, 202 (56% men, median age 68 years) patients with acute type A aortic dissection underwent surgical repair. Clinical data, image findings, methods of circulatory support, and repair technique were retrospectively investigated to explore the risk factor of postoperative stroke. RESULTS Of 202 patients, operative mortality was 6% and the incidence of postoperative stroke was 12% (n=25). Brachiocephalic artery dissection was associated with a higher risk of stroke (odds ratio, 3.89, 95%CI 1.104-13.780; P= .035) having no relation with the presence or absence of left common carotid artery dissection. Preoperative malperfusion syndrome, circulatory arrest time, isolated cerebral perfusion time, repair technique (total arch replacement), and femoral artery perfusion alone were not related to the incident rate of postoperative stroke. Stroke occurred in both hemispheres, regardless of the laterality of carotid artery dissection. CONCLUSION Brachiocephalic artery dissection was an independent risk factor of stroke after acute type A aortic dissection repair.

Peer review status:ACCEPTED

28 Oct 2020Submitted to Journal of Cardiac Surgery
29 Oct 2020Submission Checks Completed
29 Oct 2020Assigned to Editor
02 Nov 2020Reviewer(s) Assigned
11 Dec 2020Review(s) Completed, Editorial Evaluation Pending
12 Dec 2020Editorial Decision: Revise Minor
16 Dec 20201st Revision Received
17 Dec 2020Submission Checks Completed
17 Dec 2020Assigned to Editor
17 Dec 2020Review(s) Completed, Editorial Evaluation Pending
18 Dec 2020Editorial Decision: Accept