Impact of Deep Hypothermic Circulatory Arrest with Antegrade Cerebral Perfusion on Cognitive Function_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QINWei , HUANGFu-hua ,  CHENXin , XIAOLi-qiong , SHIHong-wei , XUMing , WANGLi-ming

Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, P. R. China;

Corresponding author：

CHENXin, Email: stevecx@sina.com

Keywords：

Deep hypothermic circulatory arrest; Antegrade cerebral perfusion; Aortic dissection; Cognitive function; Mini-mental status examination

DOI：

10.7507/1007-4848.20140019

Video：

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Objective To investigate the impact of deep hypothermic circulatory arrest (DHCA) with antegrade cerebral perfusion (ACP) on cognitive function of patients undergoing surgical therapy for acute Stanford type A aortic dissection (AD). Methods Between January 2009 and March 2012, 48 patients with acute Stanford type A AD underwent Sun's procedure (aortic arch replacement combined with stented elephant trunk implantation) under DHCA with ACP in Nanjing Hospital affiliated to Nanjing Medical University. There were 40 males and 8 females with their age of 51.3±13.6 years. Circulatory arrest time and time for postoperative consciousness recovery were recorded. Preoperative and postoperative cognitive functions of each patient were evaluated by mini-mental status examination (MMSE). Results Mean cardiopulmonary bypass time of the 48 patients was 237.3±58.5 minutes, and mean circulatory arrest time was 37.3 ±6.9 minutes. Four patients died postoperatively with the causes of death including lung infection, multiple organ dysfunction syndrome, myocardial infarction and acute respiratory distress syndrome. Forty-one patients recovered their consciousness within 24 hours postoperatively, and the mean time for postoperative consciousness recovery was 15.3±6.5 hours. Preoperative MMSE score was 28.6±1.1 points, and MMSE score at 1 week postoperatively was 23.6±4.5 points. Thirty-one patients were followed up for 6 months with the follow-up rate of 70.45%. The average MMSE score of the 31 patients at 6 months after surgery was 27.6±2.1 points which was significantly higher than postoperative average MMSE score (P < 0.05), but not statistically different from preoperative average MMSE score (P > 0.05). Conclusions DHCA with ACP can provide satisfactory cerebral protection for patients undergoing surgical therapy for acute Stanford type A AD, but patients' cognitive function may be adversely affected in the short term. As long as cerebral infarction or hemorrhage is excluded in CT scan of the brain, such adverse impact may generally disappear automatically within 6 months after surgery.

Citation： QINWei, HUANGFu-hua, CHENXin, XIAOLi-qiong, SHIHong-wei, XUMing, WANGLi-ming. Impact of Deep Hypothermic Circulatory Arrest with Antegrade Cerebral Perfusion on Cognitive Function. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 71-74. doi: 10.7507/1007-4848.20140019 Copy

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2.	Burkhart CS, Steiner LA.Can postoperative cognitive dysfunction be avoided? Hosp Pract (Minneap), 2012, 40 (1):214-223.
3.	Haldenwang PL, Wahlers T, Himmels A, et al.Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients Eur J Cardiothorac Surg, 2012, 42 (5):115-120.
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8.	Liu ZG, Sun LZ, Chang Q, et al.Should the "elephant trunk" be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection.J Thorac Cardiovasc Surg, 2006, 131 (1):107-113.
9.	Gega A, Rizzo JA, Johnson MH, et al.Straight deep hypothermic arrest:experience in 394 patients supports its effectiveness as a sole means of brain preservation.Ann Thorac Surg, 2007, 84 (3):759-766.
10.	Ueda Y.What is the best method for brain protection in surgery of the aortic arch? Retrograde cerebral perfusion.Cardiol Clin, 2010, 28 (2):371-379.
11.	Harrington DK, Ranasinghe AM, Shah A, et al.recommendations for haemodynamic and neurological monitoring in repair of acute type a aortic dissection.Anesthesiol Res Pract, 2011, 2011:949034.
12.	孙立忠, 刘永民, 杨天宇, 等.右锁骨下动脉插管体外循环技术的临床应用.中华胸心血管外科杂志, 2000, 16 (2):68-70.
13.	王军, 徐志云, 邹良建, 等.主动脉弓部手术脑保护效果临床分析.中国体外循环杂志, 2008, 6 (2):90-93.
14.	李舜伟.认知功能障碍的诊断与治疗.中国神经精神疾病杂志, 2006, 32 (2):189-191.
15.	Taşdemir O, Saritaş A, Küçüker S, et al.Aortic arch repair with right brachial artery perfusion.Ann Thorac Surg, 2002, 73 (6):1837-1842.
16.	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.
17.	孙立忠, 田良鑫, 程卫平, 等.单侧与双侧顺行性脑灌注的前瞻性随机对照研究.中华胸心血管外科杂志, 2005, 21 (3):154-156.

1. Monk TG, Price CC.Postoperative cognitive disorders.Curr Opin Crit Care, 2011, 17 (4):376-381.
2. Burkhart CS, Steiner LA.Can postoperative cognitive dysfunction be avoided? Hosp Pract (Minneap), 2012, 40 (1):214-223.
3. Haldenwang PL, Wahlers T, Himmels A, et al.Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients Eur J Cardiothorac Surg, 2012, 42 (5):115-120.
4. Conzelmann LO, Hoffmann I, Blettner M, et al.Analysis of risk factors for neurological dysfunction in patients with acute aortic dissection type A:data from the German Registry for Acute Aortic Dissection type A (GERAADA).Eur J Cardiothorac Surg, 2012, 42 (3):557-565.
5. 陈鑫, 黄福华, 徐明, 等.孙氏手术治疗急性Stanford A型主动脉夹层.中华胸心血管外科杂志, 2012, 28 (6):333-335.
6. 陶登顺, 王辉山, 姜辉, 等.DeBakey I型主动脉夹层的外科治疗.中国胸心血管外科临床杂志, 2011, 18 (3):218-221.
7. 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.
8. Liu ZG, Sun LZ, Chang Q, et al.Should the "elephant trunk" be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection.J Thorac Cardiovasc Surg, 2006, 131 (1):107-113.
9. Gega A, Rizzo JA, Johnson MH, et al.Straight deep hypothermic arrest:experience in 394 patients supports its effectiveness as a sole means of brain preservation.Ann Thorac Surg, 2007, 84 (3):759-766.
10. Ueda Y.What is the best method for brain protection in surgery of the aortic arch? Retrograde cerebral perfusion.Cardiol Clin, 2010, 28 (2):371-379.
11. Harrington DK, Ranasinghe AM, Shah A, et al.recommendations for haemodynamic and neurological monitoring in repair of acute type a aortic dissection.Anesthesiol Res Pract, 2011, 2011:949034.
12. 孙立忠, 刘永民, 杨天宇, 等.右锁骨下动脉插管体外循环技术的临床应用.中华胸心血管外科杂志, 2000, 16 (2):68-70.
13. 王军, 徐志云, 邹良建, 等.主动脉弓部手术脑保护效果临床分析.中国体外循环杂志, 2008, 6 (2):90-93.
14. 李舜伟.认知功能障碍的诊断与治疗.中国神经精神疾病杂志, 2006, 32 (2):189-191.
15. Taşdemir O, Saritaş A, Küçüker S, et al.Aortic arch repair with right brachial artery perfusion.Ann Thorac Surg, 2002, 73 (6):1837-1842.
16. 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.
17. 孙立忠, 田良鑫, 程卫平, 等.单侧与双侧顺行性脑灌注的前瞻性随机对照研究.中华胸心血管外科杂志, 2005, 21 (3):154-156.

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Impact of Deep Hypothermic Circulatory Arrest with Antegrade Cerebral Perfusion on Cognitive Function

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