title: Surgery of the thoracic aorta using deep hypothermic total circulatory arrest. Are there neurological consequences other than frank cerebral defects?
abstract: OBJECTIVE
  Deep hypothermic total circulatory arrest has reduced primary morbidity and mortality in thoracic aortic surgery. Although frank neurological deficits have been proven to be a rare complication of this technique, the rate of subtle but irreversible neuropsychological disorders remains unknown.
  
  
  METHODS
  A total of 23 patients (15 male, 8 female) who had undergone surgery for dissection or aneurysm of the thoracic aorta using deep hypothermic total circulatory arrest (mean 25.5 min, range 10-75 min) were studied retrospectively. The mean follow-up was 17 months. The following psychometric tests were conducted: a computer-based test battery to assess tonic alertness and sustained attention, the trail making test (TMT part A and B), the Münchner Gedächtnistest and a verbal learning test. In addition, a cerebral dopamine D2 receptor scintigraphy (using the SPECT technique) was performed. For comparison, 10 healthy subjects were studied.
  
  
  RESULTS
  With regard to tonic alertness, 69.6 and 30.4% were below the 50th and 10th centiles, respectively, according to age- and education-corrected standard values. The impairment in sustained attention correlated significantly with the duration of the circulatory arrest. On the tests assessing short-term memory, the patients scored 30% below their age- and education-corrected peers. In terms of long-term memory, 60.9 and 39.1% of the patients were below one and two standard deviations, respectively. Concerning speed of information processing whilst 78.3% of the patients were below the 50th and 21.7% below the 10th centile. Indicative of some persistent and functional brain alteration, the dopamine D2 receptor binding was significantly reduced when compared with healthy subjects.
  
  
  CONCLUSIONS
  These data prove a substantial and chronic reduction of higher cognitive function in some of the patients who underwent cardiac surgery using deep hypothermic total circulatory arrest; this was accompanied by a depression of the cerebral dopamine D2 receptor binding.
authors.affiliation: Department of Cardiac Surgery, Neurology, and Nuclear Medicine, University of Munich (Herzchirurgische Klinik der Ludwig-Maximilians-Universität München am Klinikum Grosshadern), Germany.
authors.forename: A
authors.initials: A
authors.lastname: Welz
authors.forename: O
authors.initials: O
authors.lastname: Pogarell
authors.forename: K
authors.initials: K
authors.lastname: Tatsch
authors.forename: J
authors.initials: J
authors.lastname: Schwarz
authors.forename: K
authors.initials: K
authors.lastname: Cryssagis
authors.forename: B
authors.initials: B
authors.lastname: Reichart
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001549:Benzamides; D001925:Brain Damage, Chronic / Q000000981:diagnostic imaging / Q000209:etiology*; D003342:Corpus Striatum / Q000000981:diagnostic imaging; D018492:Dopamine Antagonists; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011594:Psychometrics; D011759:Pyrrolidines; D017448:Receptors, Dopamine D2 / Q000502:physiology; D012016:Reference Values; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D001549:Benzamides; D018492:Dopamine Antagonists; D007457:Iodine Radioisotopes; D011759:Pyrrolidines; D017448:Receptors, Dopamine D2; C055743:3-iodo-2-hydroxy-6-methoxy-N-((1-ethyl-2-pyrrolidinyl)methyl)benzamide