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dc.contributor.authorChemtob, Raphaelle A
dc.contributor.authorFuglsang, Simon
dc.contributor.authorGeirsson, Arnar
dc.contributor.authorAhlsson, Anders
dc.contributor.authorOlsson, Christian
dc.contributor.authorGunn, Jarmo
dc.contributor.authorAhmad, Khalil
dc.contributor.authorHansson, Emma C
dc.contributor.authorPan, Emily
dc.contributor.authorArnadottir, Linda O
dc.contributor.authorMennander, Ari
dc.contributor.authorNozohoor, Shahab
dc.contributor.authorWickbom, Anders
dc.contributor.authorZindovic, Igor
dc.contributor.authorPivodic, Aldina
dc.contributor.authorJeppsson, Anders
dc.contributor.authorHjortdal, Vibeke
dc.contributor.authorGudbjartsson, Tomas
dc.date.accessioned2021-02-23T11:03:19Z
dc.date.available2021-02-23T11:03:19Z
dc.date.issued2020-07-20
dc.date.submitted2021-02
dc.identifier.citationChemtob RA, Fuglsang S, Geirsson A, Ahlsson A, Olsson C, Gunn J, et al. Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD). European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2020;58(5):1027-34.doi:10.1093/ejcts/ezaa197.en_US
dc.identifier.pmid32688394
dc.identifier.doi10.1093/ejcts/ezaa197
dc.identifier.urihttp://hdl.handle.net/2336/621673
dc.descriptionTo access publisher's full text version of this article click on the hyperlink belowen_US
dc.description.abstractObjectives: Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients. Methods: The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014. Results: Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34-3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27-2.23; P < 0.001). Conclusions: Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery. Keywords: Acute type A aortic dissection; Cardiac surgery; Cerebral malperfusion; Stroke.en_US
dc.language.isoenen_US
dc.publisherOxford University Pressen_US
dc.relation.urlhttps://academic.oup.com/ejcts/article-abstract/58/5/1027/5874069?redirectedFrom=fulltexten_US
dc.rights© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
dc.subjectAcute type A aortic dissectionen_US
dc.subjectCardiac surgeryen_US
dc.subjectCerebral malperfusionen_US
dc.subjectStrokeen_US
dc.subjectHjarta- og æðaskurðlækningaren_US
dc.titleStroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD).en_US
dc.typeArticleen_US
dc.identifier.eissn1873-734X
dc.contributor.department1Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA. 2Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark. 3Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA. 4Department of Cardiothoracic surgery, Karolinska University Hospital, Stockholm, Sweden. 5Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland. 6Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. 7Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 8Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 9Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital and University of Tampere, Tampere, Finland. 10Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden. 11Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden. 12Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital, Orebro, Sweden. 13Statistiska konsultgruppen, Gothenburg, Sweden. 14Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.en_US
dc.identifier.journalEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgeryen_US
dc.rights.accessClosed - Lokaðen_US
dc.departmentcodeTAS12
dc.source.journaltitleEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
dc.source.volume58
dc.source.issue5
dc.source.beginpage1027
dc.source.endpage1034
dc.source.countryGermany


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