A meta analysis of the incidence and influencing factors of stroke in patients with acute type A aortic dissection
10.3760/cma.j.cn112434-20241014-00250
- VernacularTitle:急性A型主动脉夹层患者术后卒中发生率及影响因素的文献荟萃分析
- Author:
Yu ZHANG
1
;
Yongting WANG
;
Jing PANG
;
Hui NIU
;
Shanshan LIU
;
Wenming ZHANG
Author Information
1. 河南省胸科医院心血管外科重症监护室，郑州 450003
- Publication Type:Journal Article
- Keywords:
Type A aortic dissection;
Stroke;
Incidence rate;
Influencing factors;
Systematic evaluation
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2025;41(7):395-403
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To systematically evaluate the incidence and influencing factors of postoperative stroke in patients with acute type A aortic dissection (ATAAD).Methods:Nine Chinese and English databases, including PubMed, Embase, CINAHL, JAMA, The Cochrane Library, CNKI, Wanfang, Vip and Chinese Biomedicine, were searched by computer to include literatures evaluating the incidence of postoperative stroke and its influencing factors in ATAAD patients. The search period was from the establishment of the database to September 2024. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata 14.0 software was used to combine the prevalence rate, and descriptive analysis of influencing factors was performed.Results:A total of 22 articles were included, including 16 734 ATAAD patients, published from 2018 to 2024. Meta-analysis results showed that the incidence of postoperative stroke in ATAAD patients was 16% (14%-18%). Subgroup analyses showed a higher incidence of postoperative stroke in patients with ATAAD in Europe (19%, 95% CI: 15%-23%), with a sample size of 1 to 300 patients (18%, 95% CI: 14%-22%), and in 2024 (20%, 95% CI: 14%-28%). Descriptive analysis shows that the factors influencing the occurrence of postoperative stroke in ATAAD patients include preoperative history (preoperative hypotension, preoperative history of stroke, history of carotid artery disease, history of cardiac arrest), intraoperative measures (total arch replacement, femoral artery intubation, anterograde cerebral perfusion, intraoperative oxygen satiation), and various types of time (cryopreservation time, extracorporeal circulation time, operation time). Conclusion:The incidence of postoperative stroke is higher in ATAAD patients. Preoperative hypotension, history of stroke before surgery, history of carotid artery disease, history of cardiac arrest, total arch replacement, femoral artery intubation, anterograde cerebral perfusion, decrease of cerebral oxygen saturation during operation, and longer hypothermia stop time, cardiopulmonary bypass time and operation time may increase the risk of postoperative stroke in ATAAD patients.
