Predictive factors for postoperative cerebral complications in patients with thoracic aortic aneurysm

Abstract
OBJECTIVE: Perioperative factors affecting the outcomes of postoperativebrain function in patients with thoracic aortic aneurysm were demonstrated.PATIENTS AND METHODS: From December 1977 to September 1994, 745 patientswith thoracic aortic aneurysm underwent 846 operations. The mean age atsurgery was 57.1 +/- 14.2 years old. Four hundred seventy-four patients hadtrue aneurysm and 372 had aortic dissection. Two hundred forty-fourpatients underwent repair in the ascending aorta, 189 arch repair, 242repair in the descending aorta. 79 replacement of the thoracoabdominalaorta, and 92 extra-anatomical bypass or thrombo-exclusion of the aorta.Conventional cardiopulmonary bypass was used in 297 patients, partialcardiopulmonary bypass through femoral access in 167, selective cerebralperfusion in 253, deep hypothermic circulatory arrest and retrogradecerebral perfusion in 50, temporary shunt in 29, and no circulatory supportwas applied in 50. Postoperative cerebral complications were divided intopermanent cerebral dysfunction. RESULTS: The early mortality rate was 15.5%(131 patients). Incremental risk factors for hospital mortality were non-preexisting cardiac lesions, ruptured aneurysm, postoperative cerebralcomplications, sepsis, bleeding, low output syndrome and renal failure.Cerebral complications occurred in 81 patients (9.6%), involving 47permanent and 34 transient sequelae. The early mortality rate in patientswith postoperative brain damage was 42.0%. The etiologies of the braindamage diagnosed by computed tomography were embolism in 41 patients,cerebral hypoperfusion in 16 and unknown in 24. Incremental risk factorsfor postoperative cerebral complications were: operation early in theseries advanced age at surgery, preoperative renal failure, aortic archlesions, atherosclerotic aneurysm, aortic arch procedures and clamping ofthe aortic arch. CONCLUSIONS: Although there was an increased incidence ofadvanced age and complex lesions in patients with aortic aneurysm, animprovement in surgical results has recently been achieved using advanceddiagnostic and surgical techniques.

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