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. 2020 Aug;34(4):527-536.
doi: 10.1007/s00540-020-02783-x. Epub 2020 May 2.

Evaluation of the risk factors for neurological and neurocognitive impairment after selective cerebral perfusion in thoracic aortic surgery

Sumi Otomo  1   2 , Kengo Maekawa  3 , Tomoko Baba  4 , Tomoko Goto  5 , Tatsuo Yamamoto  6
Affiliations

Evaluation of the risk factors for neurological and neurocognitive impairment after selective cerebral perfusion in thoracic aortic surgery

Sumi Otomo et al. J Anesth. 2020 Aug.

Abstract

Purpose: Neurologic complications are seen often after the surgery of the thoracic aorta that uses selective antegrade cerebral perfusion. The objective of this study was to evaluate the impact of atherosclerotic risk factors on neurologic complications in patients who underwent surgery to the thoracic aorta using SCP.

Methods: Data were collected retrospectively on 94 patients who underwent elective ascending aorta/aortic arch replacement. Concomitant procedures were performed as needed. All patients had magnetic resonance imaging (MRI), angiography (MRA) and carotid ultrasound before surgery. Individual cognitive status was measured using four neuropsychological tests before surgery and 7 days after extubation. We compared perioperative factors for risk factors associated with postoperative stroke and postoperative cognitive decline (POCD).

Results: 11 patients had strokes after surgery. Operation and extracorporeal circulation times were significantly longer in patients with stroke than those without stroke. Coronary artery disease and SCP time > 150 min were independently associated with postoperative stroke. Of the 83 patients without postoperative stroke, 20 suffered POCD. POCD patients had a significantly higher rate of heterogeneous carotid plaque, and operation time was significant longer in patients with POCD than those without POCD. Independent predictors of POCD were concomitant CABG, heterogeneous carotid plaque, history of cerebrovascular disease and operation time > 450 min.

Conclusions: We found that prolonged SCP time and coronary artery disease increased the risk of postoperative stroke. Heterogeneous carotid plaque, history of cerebrovascular disease, concomitant CABG and prolonged operation time were further significant predictors of POCD.

Keywords: Postoperative cognitive decline; Postoperative stroke; Selective antegrade cerebral perfusion; Thoracic aortic surgery.

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References

    1. Indja B, Fanning JP, Maller JJ, Fraser JF, Bannon PG, Vallely M, Grieve SM. Neural network imaging to characterize brain injury in cardiac procedures: the emerging utility of connectomics. Br J Anaesth. 2017;118(5):680–8. - DOI
    1. Hagl C, Ergin MA, Galla JD, Lansman SL, McCullough JN, Spielvogel D, Sfeir P, Bodian CA, Griepp RB. Neurologic outcome after ascending aorta-aortic arch operations: effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg. 2001;121:1107–21. - DOI
    1. Okita Y, Miyata H, Motomura N, Takamoto S. The Japan Cardiovascular Surgery Database Organization. A study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: analysis based on the Japan Adult Cardiovascular Surgery Database. J Thorac Cardiovasc Surg. 2015;149:S65–73. - DOI
    1. Handa N, Matsumoto M, Maeda H, Hougaku H, Ogawa S, Fukunaga R, Yoneda S, Kimura K, Kameda T. Ultrasonic evaluation of early carotid atherosclerosis. Stroke. 1990;21:1567–72. - DOI
    1. Kagawa R, Moritake K, Shima T, Okada Y. Validity of B-mode ultrasonographic findings in patients undergoing carotid endarterectomy in comparison with angiographic and clinicopathologic features. Stroke. 1996;27:700–5. - DOI

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