{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T19:20:59Z","timestamp":1772133659518,"version":"3.50.1"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,1,21]],"date-time":"2020-01-21T00:00:00Z","timestamp":1579564800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100006920","name":"University of Pennsylvania","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006920","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title\/>\n                  <jats:p\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Our goal was to evaluate postoperative outcomes in patients with type A aortic dissection with preoperative neurological deficits independent of shock.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Between 2002 and 2017, 150 of 1600 patients, operated on for aortic dissection type A in 3 centres, presented with preoperative new onset neurological deficits. Postoperative outcomes were classified using a modified Rankin Scale (mRS) as \u2018no to moderate disability\u2019 (mRS 0\u20133) or as \u2018poor clinical outcome\u2019 (mRS 4\u20136). Clinical and radiographic data were analysed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Ninety-three patients (62%) had no to moderate disability and 57 (38%) had a poor clinical outcome. The in-hospital mortality rate was 18% (28 patients). Patients with poor clinical outcomes were significantly older (P\u2009=\u20090.01) and had a significantly higher incidence of hypertension (P\u2009=\u20090.04), history of stroke (P\u2009=\u20090.03) and common carotid artery occlusion (left common carotid artery: P\u2009=\u20090.01; right common carotid artery: P\u2009&amp;lt;\u20090.01). One-third of all patients developed haemodynamic instability (P\u2009=\u20090.27). Cardiopulmonary bypass (P\u2009&amp;lt;\u20090.01) and cross-clamp (P\u2009=\u20090.03) times were significantly longer in patients with poor clinical outcomes. Age (odds ratio 1.041; P\u2009=\u20090.02) and history of stroke (odds ratio 2.651; P\u2009=\u20090.03) were predictive of poor clinical outcome; coma was not. Haemorrhagic transformation occurred in 7 patients without any independent predictors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Most patients with preoperative neurological deficit have no to moderate disability postoperatively but commonly develop preoperative haemodynamic instability. This study suggests that an immediate surgical approach may be reasonable in patients with preoperative neurological deficit or coma.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivz311","type":"journal-article","created":{"date-parts":[[2019,12,17]],"date-time":"2019-12-17T20:16:12Z","timestamp":1576613772000},"page":"613-619","source":"Crossref","is-referenced-by-count":28,"title":["Preoperative neurological deficit in acute type A aortic dissection"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3099-7254","authenticated-orcid":false,"given":"Maximilian","family":"Kreibich","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA"},{"name":"Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nimesh D","family":"Desai","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph E","family":"Bavaria","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilson Y","family":"Szeto","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prashanth","family":"Vallabhajosyula","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, 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