Abstract
Objective: Despite recent advances in surgical technique, thoracic aortic surgery remains a highly invasive procedure and there is limited information of postoperative cognitive dysfunction (POCD). The present study undertook to identify risk factors for POCD after ascending aorta or aortic arch replacement using selective cerebral perfusion (SCP).
Methods: Data were collected on 110 consecutive patients who underwent elective ascending aorta/aortic arch replacement using SCP between January 1998 and June 2012. All patients had magnetic resonance imaging, angiography and carotid ultrasound before surgery. Four cognitive tests were performed preoperatively and 1 week postoperatively. POCD was defined as a decrease in an individual's performance in more than two tests of at least 20% from baseline. Comparisons between the two groups were made with Student's t test and the χ2 or Fisher's exact test. To assess the predictors of POCD, stepwise logistic regression analysis was performed.
Results: The incidence of POCD was 39% (43/110). POCD patients had significantly higher rates of peripheral vascular disease (28 vs. 12%), coronary artery disease (63 vs. 28%), Plaque Score (PS)>10.0 (33 vs. 12%), carotid stenosis>50% (23 vs.9%), and prolonged surgery time (493±135 vs. 418±89 min). Stepwise logistic regression analysis demonstrated that the independent predictors of POCD were coronary artery disease [odds ratio (OR) 3.3], surgery time>456 min (OR 2.1), and PS >10.0 (OR 1.7).
Conclusions. Coronary artery disease, surgery time, and carotid atherosclerosis are significant independent predictors of POCD following thoracic aortic surgery that employs SCP. Preoperative evaluation with carotid ultrasound allows patient subgroups at risk to be identified in time to implement strategies aimed at reducing POCD.
