Background
Neurologic injury is still a frequent cause of mortality, morbidity, and long-lasting
disability in patients undergoing an aortic arch operation with hypothermic circulatory
arrest. The aim of this analysis was to evaluate short- and long-term outcomes in
neurologic and cognitive functions in this group of high-risk patients.
Methods
A total of 333 patients undergoing an aortic arch operation between February 2004
and June 2010 were retrospectively reviewed. Cerebral protection was obtained with
deep hypothermic circulatory arrest in 220 patients (66%) or with moderate hypothermic
circulatory arrest in 113 cases (34%). Straight deep hypothermic circulatory arrest
was adopted in 35 cases (11%), while the association with antegrade cerebral perfusion
was adopted in 271 cases (81%) and with retrograde cerebral perfusion in 27 cases
(8%). Seventy-eight patients were enrolled in a case control prospective study (mean
follow-up time = 42 months) and underwent neuropsychologic evaluations; data were
compared with those of a matched-control group of hypertensive patients without history
of cardiac operations.
Results
Forty-one out of 333 patients experienced permanent neurologic dysfunction (12%) and
83 experienced temporary neurologic dysfunctions (25%). Acute aortic dissection and
deep hypothermic circulatory arrest were significant predictors of mortality and permanent
neurologic dysfunction. Acute aortic dissection and hypothermic circulatory arrest
duration >30 minutes were significant predictors of temporary neurologic dysfunction,
while antegrade cerebral perfusion was protective on mortality. Neuropsychologic evaluations
showed no significant differences between the groups. The operative group showed worse
verbal and working memory (P = .003), worse semantic fluency (P = .036), higher degree of alexithymia (P = .004), and a lower quality of life (P = .007).
Conclusion
Although moderate hypothermic circulatory arrest with antegrade cerebral perfusion
demonstrated a lower mortality compared with deep hypothermic arrest, neurocognitive
testing demonstrated no difference between the groups. Additionally, patients undergoing
an aortic arch operation demonstrated long-term cognitive deficits and psychological
dysfunction when compared to a matched cohort of nonoperative patients.
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Article info
Publication history
Published online: April 02, 2016
Accepted:
February 4,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
