• Akram M Zaaqoq, Jason Chang, Sri Raksha Pothapragada, Lindsay Ayers, Xue Geng, Jacqueline L Russell, Sadia Ilyas, and Christian Shults.
• Department of Anesthesiology, Division of Critical Care, University of Virginia, Charlottesville, VA; Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC; Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC. Electronic address: akramzaaqoq@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2023 Dec 1; 37 (12): 252425302524-2530.

ObjectivesStroke after thoracic aortic surgery is a complication that is associated with poor outcomes. The aim is to characterize the intraoperative risk factors for stroke development.DesignA retrospective analysis.SettingTertiary, high-volume cardiac surgery center.ParticipantsPatients who had surgical repair of thoracic aortic diseases from January 1, 2017, through December 31, 2021.InterventionsNone.Measurements And Main ResultsA total of 704 patients were included, of whom 533 had ascending aortic aneurysms, and 171 had type A aortic dissection. The incidence of postoperative stroke was 4.5% (95% CI 2.9%-6.6%) for ascending aortic aneurysms compared with 12.3% (95% CI 7.8%-18.16%) in type-A aortic dissections. Patients who developed postoperative strokes had significantly lower intraoperative hemoglobin median (7.5 gm/dL [IQR 6.8-8.6] v 8.55 gm/dL [IQR 7.3-10.0]; p < 0.001). The median cardiopulmonary bypass time was 185 minutes (IQR 136-328) in the stroke group versus 156 minutes (IQR 113-206) in the nonstroke group (p = 0.014). Circulatory arrest was used in 57.8% versus 38.5% of the nonstroke patients (p = 0.017). The initial temperature after leaving the operating room was lower, with a median of 35.0°C (IQR 34-35.92) in the stroke group versus 35.5°C (IQR 35-36) in the nonstroke cohort (p = 0.021).ConclusionsThis single-center study highlighted the potential importance of intra-operative factors in preventing stroke. Lower hemoglobin, longer duration of cardiopulmonary bypass, deep hypothermic circulatory arrest, and postoperative hypothermia are potential risk factors for postoperative stroke. Further studies are needed to prevent this significant complication in patients with thoracic aortic diseases.Copyright © 2023 Elsevier Inc. All rights reserved.

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