Risk factors of cerebral complications after Stanford type A aortic dissection undergoing arch surgery
Yanyan Song, Li Liu, Bo Jiang, Yun Wang
Abstract
OBJECTIVE: To explore the risk factors of cerebral neurological complications after surgery for Stanford type A aortic arch surgery. METHODS: One hundred sixteen patients who received Stanford type A aortic dissection from January 2012 to December 2019 were recruited. All patients received surgery under deep hypothermic circulatory arrest (DHCA) and general anesthesia. They were grouped by degree of postoperative cerebral neurological complication. The related factors of cerebral neurological complications were analyzed by single-factor analysis and multi-factor logistic regression. RESULTS: Postoperative neurological complications were observed in 31 cases (26.72 %). Two groups were identified: permanent neurological dysfunction (PND) was observed in seven cases, and temporary neurological dysfunction (TND) was observed in 24 cases. In-hospital mortality was 9.48 % (11/116), with six in the cerebral complication groups and five in the non-complication group. Single-factor analysis showed the associated factors were age, stroke history, carotid plaque or stenosis, emergency surgery, renal dysfunction, hypotension, aortic clamping time, deep hypothermic circulatory arrest time, postoperative hypoxemia, postoperative low cardiac output and plasma transfusion >800 ml, and erythrocyte suspension transfusion >6 U. Multi-factor logistic analysis showed the independent predictive factors were DHCA time >40 min, plasma transfusion >800 ml, erythrocyte suspension transfusion >6 U, history of stroke, and carotid plaque or stenosis. CONCLUSION: The factors independently associated with neurological complications are DHCA time >40 min, plasma transfusion >800 ml, erythrocyte suspension transfusion >6 U, history of stroke, and carotid plaque or stenosis. Our findings suggest that patients with these risk factors should receive intervention during treatment to reduce cerebral neurological complications.