Incidence Of Postoperative Neurological Dysfunction Research Articles

Simple retrograde cerebral perfusion is as good as complex antegrade cerebral perfusion for hemiarch replacement.

Cerebral complication is a major concern after aortic arch surgery, which may lead to death. Thus, cerebral protection strategy plays the key role to obtain respectable results in aortic arch repair. Deep hypothermic circulatory arrest was introduced in 1970s to decrease the ischemic insults to the brain. However, safe duration of circulatory arrest time was limited to 30 minutes. The 1990s was the decade of evolution for cerebral protection, in which two adjuncts for deep hypothermic circulatory arrest were introduced: retrograde and antegrade cerebral perfusion (ACP) techniques. These two cerebral perfusion techniques significantly decreased incidence of postoperative neurological dysfunction and mortality after aortic arch surgery. Although there are no large prospective studies that demonstrate which perfusion technique provide better outcomes, multiple retrospective studies implicate that ACP may decrease cerebral complications compared to retrograde cerebral perfusion (RCP) when a long circulatory arrest time is required during aortic arch reconstructions. To date, many surgeons favor ACP over RCP during a complex aortic arch repair, such as total arch replacement and hybrid arch replacement. However, the question is whether the use of ACP is necessary during a short, limited circulatory arrest time, such as hemiarch replacement? There is a paucity of data that proves the advantages of a complex ACP over a simple RCP for a short circulatory arrest time. RCP with deep hypothermic circulatory arrest is the simple, efficient cerebral protection technique with minimal interference to the surgical field-and it potentially allows to flush atheromatous debris out from the arch vessels. Thus, it is the preferred adjunct to deep hypothermic circulatory arrest during hemiarch replacement in our institution.

Application of neuroendoscope in thalamic gliomas operation

Objective To explore the neuroendoscopic application in the surgical treatment of thalamic gliomas. Methods A total of 10 patients with thalamic glioma between December 2009 to December 2013 in Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed. The 10 cases include 5 cases of medial type, 3 cases of anterior type and 2 cases of abdominal rear type.The operations were performed by using neuroendoscope under the neuronavigation guidance. All the cases were followed up and measured by the Karnofsky performance scale(KPS). Results Six cases were totally removed, 3 cases were subtotally removed and 1 case underwent biopsy.2 cases suffered hemiparesis and speech difficulty after operation but recovered within 3 months.2 cases with hemiplegia improved significantly, KPS score increased from 60-70 before operation to 80-90 after operation.1 case was performed reoperation because of tumor cavity effusion.6 cases received postoperative radio-chemotherapy, 1 case was treated without any other therapy, 3 cases were regularly followed up.All cases were followed up from 3 months to 1 year, 1 case died of recurrence, KPS score of other patients increased after operation. Conclusion A portion of thalamic gliomas could be effectively removed by using neuroendoscope under the neuronavigation guidance and the incidence of postoperative neurological dysfunction could be reduced. Key words: Neuroendoscope; Glioma; Thalamus; Surgical procedures, operative

Analysis of Perioperative Factors for Neurological Dysfunction in Patients with Thoracic Aortic Surgery

Objectives: Surgical procedures for various aortic arch pathologies still result in high mortality and morbidity. Success in these aortic procedures is directly related to cerebral protection techniques during circulatory arrest. Herein, we analyzed risk factors for postoperative neurological dysfunction. Methods: Between June 2008 and April 2010, 104 patients underwent surgery for aneurysms or dissections using hypothermic circulatory arrest, with or without retrograde cerebral perfusion or antegrade cerebral perfusion. The mean age of patients was 68.5 ± 12 years, and 63.5% were male. Sixty patients were treated for acute aortic dissection, eight patients for chronic dissection, and 36 patients for a degenerative and atherosclerotic aneurysm. Results: Hospital mortality was 2.9%, and the overall post-operative neurological dysfunction rate was 16.3%. In addition, the incidence of permanent and temporary neurological dysfunction was 12.5% and 3.8%, respectively. Univariate analysis of risk factors for permanent neurological dysfunction revealed that acute aortic dissection, emergency case pre-operative neurological dysfunction, partial arch replacement, cannulation from cardiac apex, and deep hypothermic circulatory arrest plus retrograde cerebral perfusion duration were associated with post-operative permanent neurological dysfunction. Multivariate analysis revealed that pre-neurological dysfunction and deep hypothermic circulatory arrest plus retrograde cerebral perfusion duration were significant independent risk factors for permanent neurological dysfunction. Conclusions: Prolonged duration of deep hypothermic circulatory arrest plus retrograde cerebral perfusion and pre-operative neurological dysfunctions were risk factors for permanent neurological dysfunction. The moderate hypothermic circulatory arrest plus an antegrade cerebral perfusion method used at our institution can reduce the incidence of postoperative neurological dysfunction.

Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians

Off-pump coronary artery bypass (OPCAB) surgery has been successfully used in diverse patient populations and has been postulated to be safer than conventional coronary artery bypass (CCAB) surgery in some high-risk patients, including the elderly. To compare the safety of OPCAB surgery versus CCAB surgery in the octogenarian population of two large southwestern Ontario cardiac surgical units. Two hundred thirty-six consecutive octogenarians underwent primary isolated coronary artery bypass surgery from November 2000 to March 2005. Patients undergoing OPCAB surgery tended to have higher Parsonnet scores, while patients undergoing CCAB surgery had a greater number of emergent operations. The Canadian Cardiovascular Network predicted that mortality risk was similar in both groups. In-hospital mortality was similar between groups, as was postoperative myocardial infarction and new onset of renal dysfunction. However, in the OPCAB group, there was a decreased incidence of postoperative neurological dysfunction (2.3% in the OPCAB group versus 10.5% in the CCAB group, P=0.01), in particular cerebrovascular accidents (1.5% in the OPCAB group versus 7.6% in the CCAB group, P=0.05), and a decreased incidence of prolonged intubation (5.3% in the OPCAB group versus 13.3% in the CCAB group, P=0.04). Multivariable analysis found that cardiopulmonary bypass had no significant impact on mortality or length of stay. In octogenarian patients, OPCAB surgery is as safe as CCAB surgery in terms of mortality and major morbidity. Furthermore, a significant reduction in neurological dysfunction and prolonged intubation was seen in the OPCAB group compared with the CCAB group.