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Stroke in acute typ...
Stroke in acute type A aortic dissection : the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)
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- Chemtob, Raphaelle A. (author)
- Karolinska Institutet
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- Fuglsang, Simon (author)
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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- Geirsson, Arnar (author)
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven CT, USA
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- Ahlsson, Anders (author)
- Karolinska University Hospital
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- Olsson, Christian (author)
- Karolinska Institutet
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- Gunn, Jarmo (author)
- Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland,University of Turku
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- Ahmad, Khalil (author)
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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- Hansson, Emma C. (author)
- University of Gothenburg,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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- Pan, Emily (author)
- Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland,Turku University Hospital
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- Arnadottir, Linda O. (author)
- National University Hospital of Iceland,Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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- Mennander, Ari (author)
- Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital and University of Tampere, Tampere, Finland,University of Tampere
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- Nozohoor, Shahab (author)
- Lund University,Lunds universitet,Minimalinvasiv hjärtkirurgi vid hjärtklaffsjukdom,Forskargrupper vid Lunds universitet,Minimal invasive cardiac surgery in valvular heart disease,Lund University Research Groups,Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden; Department of Cardiothoracic Surgery, Lund University, Skå ne University Hospital, Lund, Sweden
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- Wickbom, Anders, 1987- (author)
- Örebro universitet,Institutionen för medicinska vetenskaper,Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
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- Zindovic, Igor (author)
- Lund University,Lunds universitet,Minimalinvasiv hjärtkirurgi vid hjärtklaffsjukdom,Forskargrupper vid Lunds universitet,Minimal invasive cardiac surgery in valvular heart disease,Lund University Research Groups,Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden; Department of Cardiothoracic Surgery, Lund University, Skå ne University Hospital, Lund, Sweden
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- Pivodic, Aldina (author)
- University of Gothenburg,Statistiska konsultgruppen, Gothenburg, Sweden; Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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- Jeppsson, Anders (author)
- University of Gothenburg,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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- Hjortdal, Vibeke (author)
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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- Gudbjartsson, Tomas (author)
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland,National University Hospital of Iceland
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(creator_code:org_t)
- 2020-07-20
- 2020
- English 8 s.
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In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940 .- 1873-734X. ; 58:5, s. 1027-1034
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Abstract
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- OBJECTIVES: 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- Acute type A aortic dissection
- Cardiac surgery
- Cerebral malperfusion
- Stroke
- Cardiac surgery
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Chemtob, Raphael ...
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Fuglsang, Simon
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Geirsson, Arnar
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Ahlsson, Anders
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Olsson, Christia ...
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Gunn, Jarmo
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Ahmad, Khalil
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Hansson, Emma C.
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Pan, Emily
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Arnadottir, Lind ...
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Mennander, Ari
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Nozohoor, Shahab
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Wickbom, Anders, ...
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Zindovic, Igor
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Pivodic, Aldina
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Jeppsson, Anders
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Hjortdal, Vibeke
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Gudbjartsson, To ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
- Articles in the publication
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European journal ...
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European Journal ...
- By the university
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Lund University
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Örebro University
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Karolinska Institutet