Factors Influencing Permanent Neurologic Dysfunction and Mortality after Total Arch Replacement with Separate Arch Vessel Grafting Using Selective Cerebral Perfusion

Abstract

Objectives: The present study was undertaken to identify risk factors for permanent neurological dysfunction (PND) and in-hospital mortality after total aortic arch replacement (TAR) with separate arch vessel grafting using selective cerebral perfusion (SCP) and hypothermic circulatory arrest. Methods: Between 1998 and 2008, we preformed a TAR on 143 consecutive patients in two centers by identical methods. Of these, 19 (13.3%) were emergency operations, and 46 (32.2%) were open stent-graft placements. Statistical analysis was performed to determine risk factors for PND and mortality, and furthermore, the survival rate was analyzed. Results: The in-hospital mortality rate was 4.9%, with chronic renal failure (p = 0.0013, odds ratio 10.0) as a significant risk factor. Nine patients (6.3%) had PND, with significant risk factors identified as (1) the presence of an old cerebral or silent lacunar infarction on preoperative imaging methods ( p = 0.0458, odds ratio 8.0) and (2) duration of SCP ( p = 0.0026, odds ratio 1.036). Long-term survival was the same in patients with or without PND. Conclusion: The enhanced vulnerability of the brain in patients with a pre-existing old cerebral infarction or silent lacunar infarction is reflected by a high incidence of PND. Chronic renal failure had an impact on in-hospital mortality.

Early and mid-term outcomes of the aortic arch surgery: experience from the low-volume centre

“…These numbers are comparable with data published in the literature [9] showing that also low-volume centre can achieve acceptable results in terms of all-cause mortality. Percentage of patients with permanent or temporary neurological deficit was slightly higher, than reported in the recent literature.…”

Total arch repair with frozen elephant trunk using the “zone 0 arch repair” strategy for type A acute aortic dissection

“…Would arch vessel reconstruction correlate to development of neurologic dysfunction during the reconstruction? A history of neurologic events, 22 older age, 23 or urgency 24 has been shown to be a significant risk factor for intraoperative neurologic events under SCP. However, a multicenter study investigating brain protection using SCP demonstrated that the duration of cerebral perfusion had no impact on neurologic outcome.…”

Selective cerebral perfusion with 4-branch graft total aortic arch replacement: Outcomes in 12 patients

“…Because the duration of hypothermic circulatory arrest and increasing age are important predictors of temporary neurologic dysfunction and of fine-motor and memory deficits after aortic arch surgery, reducing the duration of circulatory arrest should reduce the prevalence of these complications [20]. Lastly, while some authorities find it controversial to perform SABP in patients with acute type A dissection due to a higher risk of neurological complications, a number of very recent studies that have shown SABP for acute type A aortic dissection provides acceptable results [21-24]. …”