Predictors of Adverse Outcome and Transient Neurological Dysfunction Following Aortic Arch Replacement in 626...

Early mortality and cerebral injury are severe complications of aortic arch surgery, but data from Asian countries are scarce. We reviewed the results of patients who underwent aortic arch replacement with deep hypothermic circulatory arrest (DHCA) and antegrade selective cerebral perfusion (ASCP) at our institution to analyse pre- and intraoperative predictors of early death and neurological complications.

Clinical data of adult patients who underwent aortic arch surgery with DHCA plus ASCP between January 2005 and December 2011 were retrospectively analysed. Univariate and multivariate analyses were performed to identify predictors of adverse outcome defined as 30-day mortality and permanent neurological dysfunction (PND), and transient neurological dysfunction (TND).

A total of 626 patients were included in the study. The average age of the patients was 45.0±10.7 years with male predominance (77.0%). The incidence of adverse outcome was 5.8%, consisting of 4.6% 30-day mortality and 1.9% PND. Transient neurological dysfunction was found in 13.9% patients. Multiple logistic regression showed that stroke (OR=7.846, 95% CI: 2.737-22.489, p<0.001), emergency (OR=2.198, 95% CI: 1.019-4.740, p=0.045), CPB time (OR=1.009, 95% CI: 1.004-1.014, p<0.001), CABG (OR=2.613, 95% CI: 1.066-6.405, p=0.036) and packed red blood cells (OR=1.113, 95% CI: 1.038-1.193, p=0.003) were independent predictors of adverse outcome, and acute type A aortic dissection (OR=2.635, 95% CI: 1.535-4.524, p<0.001), preoperative neurological deficits (OR=5.326, 95% CI: 1.529-18.548, p=0.009), CPB time (OR=1.004, 95% CI: 1.000-1.007, p=0.026) and cerebral low-flow time (OR=1.034, 95% CI: 1.003-1.066, p=0.033) were associated with TND.

A history of stroke was a strong predictor of adverse outcome, and acute type A aortic dissection and preoperative neurological deficits had a high correlation with TND. The predictors identified in this study may help clinicians to optimise the risk evaluation and perioperative clinical management of patients undergoing aortic arch surgery to reduce morbidity and mortality.