Analysis of Perioperative Factors for Neurological Dysfunction in Patients with Thoracic Aortic Surgery

Abstract

Manabu Shiraishi, Shin-ichi Ohki, Arata Muraoka, Kei Aizawa, Yasuhito Sakano, Yuichiro Kaminishi, Yoshio Misawa

Objectives: Surgical procedures for various aortic arch pathologies still result in high mortality and morbidity. Success in these aortic procedures is directly related to cerebral protection techniques during circulatory arrest. Herein, we analyzed risk factors for postoperative neurological dysfunction. Methods: Between June 2008 and April 2010, 104 patients underwent surgery for aneurysms or dissections using hypothermic circulatory arrest, with or without retrograde cerebral perfusion or antegrade cerebral perfusion. The mean age of patients was 68.5 ± 12 years, and 63.5% were male. Sixty patients were treated for acute aortic dissection, eight patients for chronic dissection, and 36 patients for a degenerative and atherosclerotic aneurysm. Results: Hospital mortality was 2.9%, and the overall post-operative neurological dysfunction rate was 16.3%. In addition, the incidence of permanent and temporary neurological dysfunction was 12.5% and 3.8%, respectively. Univariate analysis of risk factors for permanent neurological dysfunction revealed that acute aortic dissection, emergency case pre-operative neurological dysfunction, partial arch replacement, cannulation from cardiac apex, and deep hypothermic circulatory arrest plus retrograde cerebral perfusion duration were associated with post-operative permanent neurological dysfunction. Multivariate analysis revealed that pre-neurological dysfunction and deep hypothermic circulatory arrest plus retrograde cerebral perfusion duration were significant independent risk factors for permanent neurological dysfunction. Conclusions: Prolonged duration of deep hypothermic circulatory arrest plus retrograde cerebral perfusion and pre-operative neurological dysfunctions were risk factors for permanent neurological dysfunction. The moderate hypothermic circulatory arrest plus an antegrade cerebral perfusion method used at our institution can reduce the incidence of postoperative neurological dysfunction.