Thoracic aortic surgery with moderate circulatory arrest and cold selective antegrade cerebral perfusion: A multivariate analysis in elective patients

Introduction: This study was undertaken to identify pre and perioperative risk factors on mortality and permanent (PND) as well as temporary neurological dysfunction (TND).

Methods: Between 11/99 and 03/06, 319 patients (median age 65yrs (21–86), 201 male) underwent elective aortic arch surgery with moderate HCA (25±2°C) and additional SACP (14°C). Sixty-nine had additional CABG or valve procedures. Ninty-four (29%) had a total arch repair. Statistical analysis was carried out to determine risk factors for 30-day mortality as well as for TND and PND.

Results: Overall mortality was 7.8% (15% in redos vs. 4.8% in non-redos, p=0.002). Twenty-seven (8.5%) suffered from PND, 6 (22%) of them died during hospital stay (p=0.004). TND was detected in 32 pts (10%). Multivariate analysis revealed age (p=0.001, Odds Ratio [OR] 1.09/yrs); redo surgery (p=0.008, OR 5.04); preoperative neurological events (p=0.004, OR 3.44), CAD (p=0.051, OR 3.58) and CPB time (p<0.001, OR 1.01/min) as risk factors for mortality. PND was associated with preoperative renal insufficiency (p=0.026, OR 3.34) and OR-time (p<0.001, OR 1.01/min), whereas TND occurred in patients with CAD (p=0.04, OR 2.41), and prolonged CPB duration (p=0.05, OR 1.01/min).Concomitant procedures or more extended arch procedures had no impact on any adverse event.

Conclusion: Elective thoracic aortic surgery including the aortic arch using HCA and SACP can be performed with excellent results, especially in those without prior sternotomy. PND is associated with high hospital mortality. Neurological complications seem to be strongly associated with general atherosclerotic changes as well as the extent of the operation.