Risk Factors for Postoperative Permanent Neurological Dysfunction After Stanford Type A Aortic Dissection: A Systematic Review and Meta-Analysis of 11382 Cases

Abstract

Objective: To systematically evaluate the risk factors for permanent neurological dysfunction (PND) after Stanford type A aortic dissection (TAAD). Method: Electronic databases included PubMed, Embase, Web of Science, CNKI, WanFang Data, VIP, and CBM. We collected studies about risk factors for PND after TAAD was published from inception to December 2021. Two authors independently assessed the quality of the studies, and a meta-analysis was performed by RevMan 5.3 Software. Results: A total of 20 studies involved 11382 cases, and among them, 1321 patients suffered PND, including 34 predictive risk factors. The meta-analysis showed that age (OR=1.11, 95% CI (1.06, 1.16), P < 0.0001), preoperative PND (OR=2.95, 95% CI (2.14, 4.07), P < 0.00001), retrograde tear in the ascending aorta (OR=6.67, 95% CI (3.23, 13.79), P < 0.00001) were independent risk factors for PND after TAAD surgery. Conclusions: Current evidence shows that age, preoperative PND, retrograde tearing in the ascending aorta are risk factors for PND after TAAD. These factors can be used to identify high-risk patients, providing guidance for medical staff to develop perioperative preventive strategies to reduce the incidence of PND. The results should be validated by higher-quality studies.