Abstract
BackgroundPostoperative cerebral complications (PCC) are common and serious postoperative complications for patients with Stanford type A aortic dissection (AAD). The aim of this study was to evaluate the risk factors for PCC in these patients and to provide a scientific basis for effective prevention of PCC.MethodsIn this retrospective case-control study, 125 patients with AAD who underwent thoracotomy in our department from October 2017 to October 2018 in the department of cardiovascular surgery, Fujian Medical University Union Hospital were divided into two groups: patients with PCC (n = 12), and patients without PCC (n = 113). The general clinical data, the types of corrective surgeries, the intraoperative situations, the postoperative complications, and the midterm outcomes of the patients were analyzed.ResultsThe patients with PCC were significantly older than the patients without PCC (P = 0.016), and the incidence of the preoperative cerebral disease history in the patients with PCC was significantly higher than those of the PCC (−) group (P = 0.024). The Euro SCORE II of patients with PCC was dramatically higher than the patients without PCC (P = 0.005). There were significant differences between the two groups in terms of the duration of cardiopulmonary bypass (CPB) (P = 0.010) and the length of moderate hypothermic circulatory arrest (MHCA) combined with selective cerebral perfusion (SCP) (P = 0.000). The monitoring of rcSO2 indicated that there was significant difference between the two groups in terms of the bilateral baseline (P = 0.000). Patients with PCC were observed to have experienced significantly longer intubation times (P = 0.000), ICU stays (P = 0.001), and postoperative hospital stays (P = 0.009), and they also had dramatically higher rates of pulmonary infection (P = 0.000), multiple organ dysfunction syndrome (P = 0.041) and tracheotomy (P = 0.022) after surgeries. The duration of MHCA+SCP (OR:9.009, P = 0.034) and the average baseline value of rcSO2 (OR:0.080, P = 0.009) were ultimately identified as significant risk factors.ConclusionsPCC has a serious influence on the prognoses of patients following surgical treatment with AAD. The duration of MHCA+SCP and the average baseline value of rcSO2 were the independent risk factors for PCC.
Highlights
Postoperative cerebral complications (PCC) are common and serious postoperative complications for patients with Stanford type A aortic dissection (AAD)
General clinical data Seventy-five patients were excluded from this study after meeting the exclusion criteria described above, including 9 cases who were younger than 18 years old, 42 cases with an abnormal preoperative consciousness, 8 cases died before surgeries, 13 cases who did not agree to participate in this clinical study, 3 cases who were lost within the 12-month follow-up period
The primary analyses revealed that the patients in the PCC (+) group were significantly older than the patients in the PCC (−) group (58.4 ± 8.4 years vs 49.4 ± 13.4 years, P = 0.016), and the incidence of preoperative cerebral disease history in the patients of the PCC (+) group was significantly higher than that of the PCC (−) group (16.7% vs 0.9%, P = 0.024)
Summary
Postoperative cerebral complications (PCC) are common and serious postoperative complications for patients with Stanford type A aortic dissection (AAD). The aim of this study was to evaluate the risk factors for PCC in these patients and to provide a scientific basis for effective prevention of PCC. The intraoperative cerebral protection strategy has been modified in recent decades, the morbidity due to postoperative cerebral complications (PCC) have been reported to be 6.4%~ 16.9% in cardiovascular surgical centers around the world [1,2,3] It is extremely important for cardiovascular surgeons and ICU physicians to explore the pathogenesis of PCC.
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