Patients with type A acute aortic dissection presenting with major brain injury: Should we operate on them? Marco Di Eusanio, MD, PhD, Himanshu J. Patel,

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Presentation transcript:

Patients with type A acute aortic dissection presenting with major brain injury: Should we operate on them? Marco Di Eusanio, MD, PhD, Himanshu J. Patel, MD, Christoph A. Nienaber, MD, FACC, FESC, Daniel M. Montgomery, BS, Amit Korach, MD, Thoralf M. Sundt, MD, Carlo DeVincentiis, MD, Matthias Voehringer, MD, Mark D. Peterson, MD, PhD, Truls Myrmel, MD, PhD, Gianluca Folesani, MD, Magnus Larsen, MD, Nimesh D. Desai, MD, Joseph E. Bavaria, MD, Jehangir J. Appoo, MD, Teresa M. Kieser, MD, Rossella Fattori, MD, Kim Eagle, MD, Roberto Di Bartolomeo, MD, Santi Trimarchi, MD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 3, Pages S213-S221.e1 (March 2013) DOI: 10.1016/j.jtcvs.2012.11.054 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 On binary logistic regression analysis, surgery was protective against mortality in patients with preoperative brain injury (cerebrovascular accident or coma; odds ratio, 0.058; 95% confidence interval, 0.018-0.192; P < .001), but hypotension/shock/tamponade (odds ratio, 3.4; 95% confidence interval, 1.365-8.415; P = .009) and renal failure (odds ratio, 3.4; 95% confidence interval, 1.292-9.159; P = .013) were independent risk factors for reduced hospital survival. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S213-S221.e1DOI: (10.1016/j.jtcvs.2012.11.054) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 In surgically treated patients, the only independent predictor of hospital death was hypotension/shock/tamponade (odds ratio, 5.4; 95% confidence interval, 0.018-0.192; P = .009); however, brain injury reversal was protective against hospital mortality (odds ratio, 0.014; 95% confidence interval, 0.069-0.742; P = .226). The Journal of Thoracic and Cardiovascular Surgery 2013 145, S213-S221.e1DOI: (10.1016/j.jtcvs.2012.11.054) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Kaplan-Meier survival curves stratified by presence and type of brain injury in A, overall population of patients with type A acute dissection, B, patients receiving medical management, and C, patients undergoing surgical repair. CVA, Cerebrovascular accident. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S213-S221.e1DOI: (10.1016/j.jtcvs.2012.11.054) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Kaplan-Meier survival curves of patients with type A acute aortic dissection presenting with major brain injury stratified by therapeutic management. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S213-S221.e1DOI: (10.1016/j.jtcvs.2012.11.054) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions