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

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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.

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Acknowledgements

The authors thank Dr. Jon Moon for his editorial assistance and Dr. Akira Kitagawa for his statistical assistance.

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Authors and Affiliations

  1. Department of Anesthesiology, National Hospital Organization Kumamoto Saishun Medical Center, 2659 Suya, Koushi, Kumamoto, 861-1196, Japan

    Sumi Otomo

  2. Department of Anesthesiology, Kumamoto Chuo Hospital, Kumamoto, Japan

    Kengo Maekawa

  3. Department of Anesthesiology, Minamata City Hospital and Medical Center, Kumamoto, Japan

    Tomoko Baba

  4. Department of Anesthesiology, Itoh Dento-Maxillofacial Hospital, Kumamoto, Japan

    Tomoko Goto

  5. Department of Anesthesiology, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan

    Sumi Otomo & Tatsuo Yamamoto

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  1. Sumi Otomo
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  2. Kengo Maekawa
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  3. Tomoko Baba
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  5. Tatsuo Yamamoto
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Correspondence to Sumi Otomo.

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Otomo, S., Maekawa, K., Baba, T. et al. Evaluation of the risk factors for neurological and neurocognitive impairment after selective cerebral perfusion in thoracic aortic surgery. J Anesth 34, 527–536 (2020). https://doi.org/10.1007/s00540-020-02783-x

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  • DOI: https://doi.org/10.1007/s00540-020-02783-x

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