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J Thorac Cardiovasc Surg 2002;124:1080-1086
© 2002 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology (CSP) |
From the Department of Cardiopulmonary Surgery,a St Antonius Hospital, Nieuwegein, The Netherlands, and Department of Cardiac Surgery,b Policlinico S. Orsola, University of Bologna, Bologna, Italy.
Received for publication Oct 18, 2001. Revisions requested March 5, 2002; revisions received March 12, 2002. Accepted for publication March 24, 2002. Address for reprints: Marco Di Eusanio, MD, Department of Cardiopulmonary Surgery, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, The Netherlands.
Objective: We retrospectively analyzed hospital mortality and neurologic outcome after operations on the thoracic aorta with the aid of antegrade selective cerebral perfusion to determine a predictive risk model.
Methods: Between October 1995 and May 2001, 413 patients (mean age, 63.0 ± 11.5 years) underwent operations on the thoracic aorta with antegrade selective cerebral perfusion. Indications for surgical intervention were acute type A dissection in 116 (28.1%) patients, degenerative aneurysm in 227 (55.0%) patients, and postdissection aneurysm in 70 (16.9%) patients. One hundred twenty-five (30.3%) patients were operated on urgently; concomitant procedures were performed in 171 (41.4%) patients. Mean cerebral perfusion time was 63.0 ± 38.7 minutes (range, 16-220 minutes). Preoperative and intraoperative factors were evaluated by means of univariate and multivariate analysis to identify predictors of hospital mortality and neurologic outcome.
Results: The hospital mortality was 9.4%. Stepwise logistic regression revealed urgency status (P = .000; odds ratio, 19.9) and recent history of a recent central neurologic event (P = .004; odds ratio, 8.0) to be independent determinants for hospital mortality. Temporary neurologic dysfunction occurred in 20 (5.1%) patients. Urgency status (P = .005; odds ratio, 7.5), history of a central neurologic event (P = .003; odds ratio, 8.6), and coronary artery bypass grafting (P = .019; odds ratio, 6.0) were independent determinants of temporary neurologic dysfunction. Urgency status (P = .003; odds ratio, 8.6) was the only independent determinant for permanent neurologic dysfunction, and it occurred in 15 (3.7%) patients.
Conclusion: Antegrade selective cerebral perfusion is an effective method of brain protection. Cerebral perfusion times of longer than 90 minutes were not associated with an increased risk of hospital mortality or poorer neurologic outcome. Urgency status and recent history of central neurologic events were retained as important risk factors for hospital mortality and neurologic outcome.
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