BACKGROUND: Data on the prognostic impact of type A aortic dissection involving the common carotid arteries (CCAs) are scarce. METHODS: Data on the status of the CCAs were available in 1106 patients who underwent surgery for acute DeBakey type 1 aortic dissection who were recruited in a retrospective, multicentre European registry, that is, the ERTAAD. Postoperative neurological complications were defined as ischaemic stroke, haemorrhagic stroke and/or global brain ischaemia. RESULTS: Patients without carotid artery dissection, those with unilateral or bilateral CCA dissection had in-hospital mortality rates of 19.5%, 16.9% (OR 1.006, 95% CI 0.614 to 1.647) and 27.3% (p<0.001, OR 1.719, 95% CI 1.086 to 2.722), respectively. Bilateral, but not unilateral, dissection of the CCAs increased the risk of neurological complications (40.0% vs 18.9%, OR 2.453, 95% CI 1.683 to 3.576). The negative prognostic effect of bilateral dissection of the CCAs was increased among patients without cerebral malperfusion who underwent surgery with the use of hypothermic circulatory arrest (28.7% vs 4.3%, p=0.014). CONCLUSIONS: Bilateral, but not unilateral, dissection of the CCAs may increase the risk of neurological complications and in-hospital mortality after surgery for DeBakey type 1 aortic dissection. TRIAL REGISTRATION NUMBER: NCT04831073.

Cardiac Surgery Molinette Hospital University of Turin Torino Italy

Cardiothoracic Department Azienda Sanitaria Universitaria Friuli Centrale University of Udine Udine Italy

Cardiovascular Surgery Department Hospital General Universitario Gregorio Maranon Madrid Spain

Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy

Department of Cardiac Surgery 3rd Faculty of Medicine University Hospital Kralovske Vinohrady Praha Czech Republic

Department of Cardiac Surgery Centre Hospitalier Annecy Genevois Epagny Metz Tessy France

Department of Cardiac Surgery Glenfield Hospital Leicester UK

Department of Cardiac Surgery Ludwig Maximilian University of Munich Munchen Germany

Department of Cardiac Surgery Martin Luther University Halle Wittenberg Halle Germany

Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Cardiothoracic Surgery University Hospital Munster Muenster Germany

Department of Cardiovascular Surgery Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico Milano Italy

Department of Cardiovascular Surgery Hospital Clínic de Barcelona University of Barcelona Barcelona Spain

Department of Cardiovascular Surgery University of Hamburg Hamburg Germany

Department of Medicine South Karelia Social and Health Care Districtm University of Helsinki Lappeenranta Finland

Department of Thoracic and Cardiovascular Surgery Centre Hospitalier Universitaire de Besancon Besancon France

Division of Cardiac Surgery Cardio thoracic and Vascular Department Azienda sanitaria universitaria Giuliano Isontina Trieste Italy

Division of Cardiac Surgery University of Verona Verona Italy

German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany

Helsinki University Hospital Heart and Lung Center Helsinki Finland

Liverpool Centre for Cardiovascular Sciences Liverpool Heart and Chest Hospital University of Liverpool Liverpool UK

National Center for Global Health Istituto Superiore di Sanità Roma Italy

Universite Paris Est Creteil Val de Marne Creteil France

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NCT04831073