Perioperative cerebral perfusion in aortic arch surgery: a potential link with neurological outcome

Abstract

OBJECTIVE To examine whether perioperative changes in cerebral blood flow relate to postoperative neurological deficits in patients undergoing aortic arch surgery involving antegrade selective cerebral perfusion. METHODS We retrospectively analysed data from patients who underwent aortic arch surgery involving antegrade selective cerebral perfusion and perioperative transcranial Doppler assessments. Linear mixed-model analyses were performed to examine perioperative changes in mean bilateral blood velocity in the middle cerebral arteries, reflecting changes in cerebral blood flow, and their relation with neurological deficits, i.e. ischaemic stroke and/or delirium. Logistic regression analyses were performed to explore possible risk factors for postoperative neurological deficits. RESULTS In our study population (N = 102), intraoperative blood velocities were lower compared to preoperative levels, and lowest during antegrade selective cerebral perfusion. 36 (35%) patients with postoperative neurological deficits (ischaemic stroke, n = 9; delirium, n = 25; both, n = 2) had lower blood velocity during antegrade selective cerebral perfusion compared to patients without (25.4 vs 37.0 cm/s; P = 0.002). Logistic regression analyses revealed lower blood velocity during antegrade selective cerebral perfusion as an independent risk factor for postoperative neurological deficits (odds ratio = 0.959; 95% CI: 0.923, 0.997; P = 0.037). CONCLUSIONS Lower intraoperative cerebral blood flow during antegrade selective cerebral perfusion seems independently related to postoperative neurological deficits in patients undergoing aortic arch surgery. Because cerebral blood flow is a modifiable factor during antegrade selective cerebral perfusion, our observation has significant potential to improve clinical management and prevent neurological deficits.

Prevalence of carotid artery stenosis and intra-cranial lesions in patients with aortic arch aneurysm and its association with intraoperative regional cerebral oxygen saturation and postoperative neurological outcomes

“…Cerebral protection during aortic arch aneurysm repair is managed by hypothermia and mechanical cerebral perfusion, which are also often guided by near-infrared spectroscopy (NIRS). Despite these techniques, the incidence of postoperative cerebral vascular events for patients with aortic arch aneurysms remains high, reported to be approximately 4.7–7.3% and 10.3% for permanent and temporary neurological deficits, respectively ( 2 ).…”