{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:37:43Z","timestamp":1788914263434,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T00:00:00Z","timestamp":1703289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Postoperative neurological complications (NCs) are an important cause of mortality in patients with acute type A aortic dissection (ATAAD). The aim of the study was to determine the association between intraoperative risk factors and newly developed postoperative NCs in patients after emergency surgery for ATAAD. Materials and Methods: A total of 203 patients requiring emergency surgery were included in the study. Patients with preoperative neurological dysfunction, deceased on the operating table or within the first 48 h after intensive care admission, with uncertain postoperative neurologic status or with incomplete records were excluded. Results: Mean age was 57.61 \u00b1 12.27 years. Hyperlipidemia was the most frequent comorbidity (69%). A bicuspid aortic valve was present in 12.8% of cases, severe acute aortic regurgitation was present in 29.1% of patients, and cardiac tamponade was present in 27.1% of cases. The innominate artery was the most frequently dissected supra-aortic artery in 27.1% of cases. In 65% of cases, the primary entry tear was at the level of the ascending aorta. The incidence of newly developed postoperative NCs was 39.4%. The most common surgical technique performed was supra-coronary ascending aorta and hemiarch replacement, in 53.2% of patients. Using logistic regression, cardiopulmonary bypass time (OR = 1.01; 95% CI = 1.01\u20131.02; p &lt; 0.001), aortic cross-clamp time over 3 h (OR = 2.71, 95% CI = 1.43\u20135.14, p = 0.002) and cerebral perfusion time (OR = 1.02; 95% CI = 1.002\u20131.03; p = 0.027) were independently associated with newly developed postoperative NCs. Conclusions: Based on the results of the study, all efforts should be made to reduce operative times. Using a simple surgical technique, like the supra-coronary ascending aorta and hemiarch technique, whenever possible, and using a simpler technique for cerebral perfusion like unilateral cerebral perfusion via the right axillary artery, could reduce operating times.<\/jats:p>","DOI":"10.3390\/medicina60010027","type":"journal-article","created":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T20:44:15Z","timestamp":1703450655000},"page":"27","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Factors Associated with Newly Developed Postoperative Neurological Complications in Patients with Emergency Surgery for Acute Type A Aortic Dissection"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3599-129X","authenticated-orcid":false,"given":"Mircea","family":"Robu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina Maria","family":"Margarint","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiac Surgery, Emergency Clinical Hospital for Children \u201cMaria Sk\u0142odowska Curie\u201d, 077120 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornel","family":"Robu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8787-5018","authenticated-orcid":false,"given":"Andreea","family":"Hanganu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Neurology Department, Fundeni Clinical Institute, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Radulescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ovidiu","family":"Stiru","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei","family":"Iosifescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Preda","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Cacoveanu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Voica","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9069-2722","authenticated-orcid":false,"given":"Vlad Anton","family":"Iliescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hora\u021biu","family":"Moldovan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"},{"name":"Academy of Romanian Scientists, 050045 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1001\/jamacardio.2022.2718","article-title":"Early Mortality in Type A Acute Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection","volume":"7","author":"Harris","year":"2022","journal-title":"JAMA Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1093\/ejcts\/ezs025","article-title":"Analysis of risk factors for neurological dysfunction in patients with acute aortic dissection type A: Data from the German Registry for Acute Aortic Dissection type A (GERAADA)","volume":"42","author":"Conzelmann","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1378\/chest.117.5.1271","article-title":"Epidemiology and clinicopathology of aortic dissection","volume":"117","author":"Schmidt","year":"2000","journal-title":"Chest"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/j.1600-0404.1999.tb07352.x","article-title":"Neurologic complications of type I aortic dissection","volume":"99","author":"Blanco","year":"1999","journal-title":"Acta Neurol. Scand."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jama.283.7.897","article-title":"The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease","volume":"283","author":"Hagan","year":"2000","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1016\/j.jtcvs.2019.06.016","article-title":"Factors associated with acute stroke after type A aortic dissection repair: An analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database","volume":"159","author":"Ghoreishi","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1093\/ejcts\/ezx465","article-title":"Stroke after emergent surgery for acute type A aortic dissection: Predictors, outcome and neurological recovery","volume":"53","author":"Dumfarth","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Robu, M., Marian, D.R., Margarint, I., Radulescu, B., \u0218tiru, O., Iosifescu, A., Voica, C., Cacoveanu, M., Ciomag Ianula, R., and Ga\u0219par, B.S. (2023). Association between Bilateral Selective Antegrade Cerebral Perfusion and Postoperative Ischemic Stroke in Patients with Emergency Surgery for Acute Type A Aortic Dissection-Single Centre Experience. Medicina, 59.","DOI":"10.3390\/medicina59081365"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lee, S.J., Kim, J.H., Na, C.Y., Oh, S.S., Kim, Y.M., Lee, C.K., and Lim, D.S. (2013). Eleven years of experience with the neurologic complications in Korean patients with acute aortic dissection: A retrospective study. BMC Neurol., 13.","DOI":"10.1186\/1471-2377-13-46"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.jcrc.2015.02.003","article-title":"Risk factors for postoperative delirium in patients after coronary artery bypass grafting: A prospective cohort study","volume":"30","author":"Zhang","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2122","DOI":"10.1016\/j.athoracsur.2007.01.041","article-title":"Impact of perfusion strategy on neurologic recovery in acute type A aortic dissection","volume":"83","author":"Zierer","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"II237","DOI":"10.1161\/01.CIR.0000138219.67028.2a","article-title":"Differences in clinical presentation, management, and outcomes of acute type a aortic dissection in patients with and without previous cardiac surgery","volume":"110","author":"Collins","year":"2004","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1093\/ejcts\/ezaa197","article-title":"Stroke in acute type A aortic dissection: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)","volume":"58","author":"Chemtob","year":"2020","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.jacc.2018.04.071","article-title":"Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization","volume":"72","author":"Head","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/S0003-4975(02)04370-9","article-title":"Stroke after cardiac surgery: A risk factor analysis of 16,184 consecutive adult patients","volume":"75","author":"Bucerius","year":"2003","journal-title":"Ann. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1161\/01.STR.0000199032.78782.6c","article-title":"Stroke and encephalopathy after cardiac surgery: An update","volume":"37","author":"McKhann","year":"2006","journal-title":"Stroke"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"309","DOI":"10.2214\/ajr.181.2.1810309","article-title":"Pathogenesis in acute aortic syndromes: Aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer","volume":"181","author":"Macura","year":"2003","journal-title":"Am. J. Roentgenol."},{"key":"ref_18","first-page":"924","article-title":"Surgical treatment of Stanford type A acute aortic dissection with stenosis of the branches of aortic arch: Report of two cases","volume":"42","author":"Nakajima","year":"1989","journal-title":"Kyobu Geka"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1055\/s-2006-948323","article-title":"Long-term neurological complications after hypoxic-ischemic encephalopathy","volume":"26","author":"Khot","year":"2006","journal-title":"Semin. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Heinz, U.E., and Rollnik, J.D. (2015). Outcome and prognosis of hypoxic brain damage patients undergoing neurological early rehabilitation. BMC Res. Notes, 8, Erratum in BMC Res. Notes 2016, 9, 396.","DOI":"10.1186\/s13104-016-2199-8"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.resuscitation.2004.10.011","article-title":"Outcome after cardiac arrest: Predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale","volume":"65","author":"Pfeifer","year":"2005","journal-title":"Resuscitation"},{"key":"ref_22","first-page":"51","article-title":"Cerebral malperfusion in acute type A aortic dissection: Should surgery proceed?","volume":"29","author":"Velho","year":"2022","journal-title":"Port. J. Card. Thorac. Vasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1159\/000518197","article-title":"Spinal Cord Ischemia Secondary to Aortic Dissection: Case Report with Literature Review for Different Clinical Presentations, Risk Factors, Radiological Findings, Therapeutic Modalities, and Outcome","volume":"13","author":"Elshony","year":"2021","journal-title":"Case Rep. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"143","DOI":"10.3389\/fneur.2017.00143","article-title":"Delayed Hospital Presentation and Neuroimaging in Non-surgical Spinal Cord Infarction","volume":"8","author":"Pikija","year":"2017","journal-title":"Front. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"668","DOI":"10.21037\/jtd-23-10","article-title":"Systematic review and meta-analysis of the risk factors for postoperative delirium in patients with acute type A aortic dissection","volume":"15","author":"Wang","year":"2023","journal-title":"J. Thorac. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"572581","DOI":"10.3389\/fmed.2020.572581","article-title":"Prevalence, Predictors, and Early Outcomes of Post-operative Delirium in Patients with Type A Aortic Dissection During Intensive Care Unit Stay","volume":"7","author":"Cai","year":"2020","journal-title":"Front. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/j.jtcvs.2007.07.067","article-title":"Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: A risk factor analysis for adverse outcome in 501 patients","volume":"135","author":"Khaladj","year":"2008","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.21037\/jtd-21-1591","article-title":"Risk factors for impaired neurological outcome after thoracic aortic surgery","volume":"14","author":"Demal","year":"2022","journal-title":"J. Thorac. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"265","DOI":"10.21037\/acs.2016.07.04","article-title":"Management of type A dissection with malperfusion","volume":"5","author":"Yang","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.ejcts.2007.04.012","article-title":"Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: Outcomes and need for additional revascularizations","volume":"32","author":"Geirsson","year":"2007","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"ezad141","DOI":"10.1093\/ejcts\/ezad141","article-title":"Validation of the German Registry for Acute Aortic Dissection Type A Score in predicting 30-day mortality after type A aortic dissection surgery","volume":"63","author":"Gemelli","year":"2023","journal-title":"Eur. J. Cardiothorac. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/1\/27\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:40:52Z","timestamp":1760132452000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/1\/27"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,23]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["medicina60010027"],"URL":"https:\/\/doi.org\/10.3390\/medicina60010027","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,23]]}}}