Risk Factor Analysis of Delayed Recovery of Consciousness after Aortic Arch Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CUI Huimin , LI Qingguo , WANG Qiang , WANG Dongjin

1. Drum Tower Clinical Medical College of Nanjing Medical University， Nanjing210029 ， P.R.China ;;
2. Department of Cardiothoracic Surgery， Affiliated Drum Tower Hospital， Medical School of NanjingUniversity， Nanjing 210008， P. R. China;

Corresponding author：

Keywords：

Deep hypothermic circulatory arrest; Antegrade selective cerebral perfusion; Aortic arch surgery; Delayed recovery of consciousness; Risk factor

DOI：

10. 7507/1007-4848. 20130051

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Objective To determine risk factors of delayed recovery of consciousness after aortic arch surgery underdeep hypothermic circulatory arrest （DHCA） and antegrade selective cerebral perfusion （ASCP）. Methods We retrospectively analyzed clinical data of 113 patients who underwent aortic arch surgery under DHCA＋ASCP in the Affiliated Drum Tower Hospital， Medical School of Nanjing University from October 2004 to April 2012. According to whether they　regained consciousness within 24 hours after surgery， all the 113 patients were divided into normal group （73 patients including 55 males and 18 females with their average age of 48.1±10.9 years） and delayed recovery group （40 patients including 29 males and 11 females with their average age of 52.2±11.4 years）. Risk factors of delayed recovery of consciousness after surgery were evaluated by univariate analysis and multivariate logistic regression analysis. Results Nine patients （8.0%） died postoperatively， including 5 patients with multi-organ failure， 2 patients with heart failure， 1 patient with mediastinal infection， and 1 patient with pulmonary hemorrhage. There were 7 deaths （17.5%） in the delayed recovery group and 2 deaths （2.7%） in the normal group， and the in-hospital mortality of the delayed recovery group was significantly higher than that of the normal group （P=0.016）. A total of 94 patients （including 65 patients in the normal group and 29　patients in the delayed recovery group） were followed up for 4-95 months. Eight patients （including 5 patients in the normal　group and 3 patients in the delayed recovery group） died during follow-up， including 2 patients with stroke， 3 patients with heart failure， 2 patients with pulmonary hemorrhage and 1 patient with unknown cause. Ten patients were lost during　follow-up. Univariate analysis showed that age （P=0.042）， hypertension （P=0.017）， emergency surgery （P=0.001）， cardiopu-　lmonary bypass （CPB） time （P=0.007）， aortic cross-clamp time （P=0.021）， and blood transfusion（P=0.012）were risk factors of delayed recovery of consciousness after aortic arch surgery. Multivariate logistic regression showed that emergency surgery （P=0.005） and CPB time＞240 minutes （P=0.000） were independent risk factors of delayed recovery of consciousness after aortic arch surgery. Conclusion Delayed recovery of consciousness after aortic arch surgery is　attributed to a combination of many risk factors. Correct patient diagnosis， lesion site and involved scope should be made clear preoperatively in order to choose appropriate surgical strategies. During the surgery， strengthened brain protection， shortened operation time， improved surgical techniques， and perioperative stable circulation maintenance are all important measures to prevent delayed recovery of consciousness after aortic arch surgery.

Citation： CUI Huimin,LI Qingguo,WANG Qiang,WANG Dongjin. Risk Factor Analysis of Delayed Recovery of Consciousness after Aortic Arch Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 163-167. doi: 10. 7507/1007-4848. 20130051 Copy

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2.	孙立忠，刘志刚，常谦，等. 主动脉弓替换加支架“象鼻”手术治疗Stanford A型主动脉夹层. 中华外科杂志， 2004， 42 （13）：812-816.
3.	Ergin MA， Uysal S， David LR， et al. Temporary neurological　dysfunction after deep hypothermic circulatory arrest：a clinical marker of long-term functional deficit. Ann Thorac Surg， 1999， 67 （6）：1887-1890.
4.	He GW， Acuff TE， Ryan WH， et al. Influence of old age， gender， and internal mammary artery grafting on operative mortality and morbidity in coronary artery bypass grafting. Am J Geriatr Cardiol， 1996， 5 （6）：22-35.
5.	陈小芳，王东进，徐标. 高血压对主动脉夹层患者术后早期中枢神经系统功能的影响. 中华高血压杂志， 2012， 20 （2）：171-174.
6.	郑斯宏，孙衍庆，孟旭，等. Stanford A 型主动脉夹层的外科治疗. 中华外科杂志， 2005， 43 （18）：1177-1180.
7.	Kazui T， Washiyama N， Muhammad BA， et al. Total arch replacement using aortic arch branched grafts with the aid of antegrade selective cerebral perfusion. Ann Thorac Surg， 2000， 70 （1）：3-8.
8.	刘楠，孙立忠，常谦，等. 主动脉弓部手术脑部并发症的危险因素分析. 中华胸心血管外科杂志， 2005， 21 （5）：272-274.
9.	田良鑫，孙立忠，程卫平，等. 单侧与双侧顺行性脑灌注对认知能力的影响. 中国胸心血管外科临床杂志， 2005， 12 （1）：8-10.
10.	董培青. 主动脉弓外科脑保护的研究进展. 中国体外循环杂志， 2010， 8 （2）：65-68.

1. 　Ueda T， Shimizu H， Ito T， et al. Cerebral complications associated with selective perfusion of the arch vessels. Ann Thorac Surg， 2000， 70 （5）：1472-1477.
2. 　孙立忠，刘志刚，常谦，等. 主动脉弓替换加支架“象鼻”手术治疗Stanford A型主动脉夹层. 中华外科杂志， 2004， 42 （13）：812-816.
3. 　Ergin MA， Uysal S， David LR， et al. Temporary neurological　dysfunction after deep hypothermic circulatory arrest：a clinical marker of long-term functional deficit. Ann Thorac Surg， 1999， 67 （6）：1887-1890.
4. 　He GW， Acuff TE， Ryan WH， et al. Influence of old age， gender， and internal mammary artery grafting on operative mortality and morbidity in coronary artery bypass grafting. Am J Geriatr Cardiol， 1996， 5 （6）：22-35.
5. 　陈小芳，王东进，徐标. 高血压对主动脉夹层患者术后早期中枢神经系统功能的影响. 中华高血压杂志， 2012， 20 （2）：171-174.
6. 　郑斯宏，孙衍庆，孟旭，等. Stanford A 型主动脉夹层的外科治疗. 中华外科杂志， 2005， 43 （18）：1177-1180.
7. 　Kazui T， Washiyama N， Muhammad BA， et al. Total arch replacement using aortic arch branched grafts with the aid of antegrade selective cerebral perfusion. Ann Thorac Surg， 2000， 70 （1）：3-8.
8. 　刘楠，孙立忠，常谦，等. 主动脉弓部手术脑部并发症的危险因素分析. 中华胸心血管外科杂志， 2005， 21 （5）：272-274.
9. 　田良鑫，孙立忠，程卫平，等. 单侧与双侧顺行性脑灌注对认知能力的影响. 中国胸心血管外科临床杂志， 2005， 12 （1）：8-10.
10. 　董培青. 主动脉弓外科脑保护的研究进展. 中国体外循环杂志， 2010， 8 （2）：65-68.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk Factor Analysis of Delayed Recovery of Consciousness after Aortic Arch Surgery

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