• Peter Chiu, Torsten J Rotto, Andrew B Goldstone, Joshua B Whisenant, Woo Y Joseph YJ Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, Calif., and Michael P Fischbein.
• Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, Calif.
• J. Thorac. Cardiovasc. Surg. 2019 Sep 1; 158 (3): 665-672.

ObjectiveNeurologic injury complicating the presentation of acute type A aortic dissection remains a challenge for cardiac surgeons.MethodsThis was a retrospective review of patients undergoing open repair of acute type A aortic dissection at our institution between January 2005 and December 2015. Evidence of neurologic injury at the time of presentation was abstracted from the medical record. Propensity-score matching was used to account for baseline differences between groups, and outcome analysis was performed using logistic regression and Kaplan-Meier analysis. Among patients with persistent neurologic deficits, a threshold for time-to-operation was evaluated using receiver operating characteristic curves.ResultsThere were 345 patients who underwent open repair for acute type A aortic dissection; 50 patients presented with neurologic injury. In the matched analysis, in-hospital mortality was greater among patients who presented with neurologic deficits (odds ratio, 4.42; 95% confidence interval, 1.15-16.97; P = .03). Among patients with persistent neurologic deficits at presentation, receiver operating characteristic curve analysis with cross-validation suggested that time-to-operation was a poor predictor of both neurologic outcome (area under the curve, 0.40) and death (area under the curve, 0.49).ConclusionsNeurologic injury at the time of presentation with acute type A aortic dissection was associated with an increased risk of in-hospital mortality. Among patients with persistent neurological deficits, time-to-operation failed to predict either neurologic outcome or perioperative mortality suggesting that longer time from onset of symptoms of neurologic injury should not act as a contraindication to proceeding to the operating room for expedient repair.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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