Abstract Objectives Cerebral malperfusion in acute type A aortic dissection (ATAAD) is a serious condition. Predicting postoperative neurological outcomes is important to decide treatment strategies; however, current prediction methods have limitations. Therefore, this study examined whether the lateral ventricular volume ratio (LVR) on preoperative head computed tomography (CT) can predict postoperative neurological outcomes. Methods Among patients who underwent surgery for ATAAD at our institution between January 2007 and August 2024, those with cerebral malperfusion who underwent preoperative head CT were included. Cerebral malperfusion was defined as common carotid artery true lumen stenosis ≥50% and new neurological symptoms. The LVR was calculated as the larger lateral ventricular volume divided by the smaller lateral ventricular volume. Results Of 386 patients with ATAAD, 33 had cerebral malperfusion and underwent preoperative CT. Receiver operating characteristic analysis determined LVR 1.067 as the cut-off, classifying patients into the symmetric group (ratio 1.067, n = 10) or the asymmetric group (ratio ≥ 1.067, n = 23). The symmetric group showed 80% postoperative neurological recovery compared with 26% in the asymmetric group (P = .007). The postoperative modified Rankin Scale score was ≥4 in 20% and 78% of patients in the symmetric and asymmetric groups, respectively (P = .005). Univariable analysis identified lateral ventricular symmetry as a predictor of postoperative neurological recovery (odds ratio = 11.3, 95% confidence interval: 1.86-69.1, P = .008). Long-term overall survival was significantly better in the symmetric group than in the asymmetric group (P = .043). Conclusions In patients with ATAAD and cerebral malperfusion, lateral ventricular symmetry on preoperative head CT may predict postoperative neurological outcomes. Clinical registration number 4707.
Takauchi et al. (Thu,) studied this question.