[Brain damage after surgery for thoracic aortic aneurysm].
We analyzed cases with brain damage after surgery for thoracic aortic aneurysm in our institution and investigated the causes, risk-factors and preventive measures for this disastrous postoperative complication. Irreversible brain damage was a complication in 25 out of 184 operative cases (13.6%) over a 21-year period. The cause of brain damage was determined to be embolism by manipulation of the aorta in six cases, clamping of the left subclavian artery in four cases, technical problems of separate cerebral perfusion (SCP) in four cases, severe shock in three cases, embolism unrelated to operative maneuver in three cases, stenosis of a branch of the arch with aortic dissection in two cases, and air embolism, circulatory arrest with insufficient hypothermia and hypoperfusion of a temporary bypass to the left carotid artery in one case each. The neurological symptom improved in eight cases and was unchanged in 17 cases. Eighteen cases died in the hospital. In the univariate analysis, age (p = 0.048), a portion of the aneurysm (p = 0.035), preoperative brain complication (p = 0.003), emergency operation (p = 0.033) and clamping of the arch (p = 0.001) were found to be prominent risk factors for brain damage. In the multivariate analysis, clamping of the arch (p = 0.0310), SCP (p = 0.0327) and emergency operation (p = 0.0223) were prominent. To prevent postoperative brain damage, the arch should not be clamped, appropriate operative techniques to avoid bleeding and to shorten SCP time should be employed, and proper and prompt management of the emergency operation and caution in clamping the left subclavian artery are considered to be necessary.
Inada
H
H
Department of Surgery, Kawasaki Medical School, Okayama, Japan.
Tabuchi
A
A
Morita
I
I
Masaki
H
H
Murakami
T
T
Fujiwara
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001927:Brain Diseases / Q000209:etiology*; D003250:Constriction; D004618:Embolism, Air / Q000209:etiology; D004630:Emergencies; D005112:Extracorporeal Circulation / Q000009:adverse effects; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D012307:Risk Factors