Neurocognitive outcome after retrograde cerebral perfusion.
BACKGROUND
Neurocognitive outcome in patients undergoing thoracic aortic surgery using retrograde cerebral perfusion (RCP) remains uncertain.


METHODS
Forty-two patients undergoing thoracic aortic surgery using RCP were enrolled in the study. The patients' neurocognitive state was assessed by the revised Wechsler Adult Intelligence Scale (WAIS-R) a few days before operation, at 2 to 3 weeks, and at 4 to 6 months after operation.


RESULTS
There were no stroke, seizure, and hospital death. Significant performance deterioration was observed in digit span, arithmetic, and picture completion of the WAIS-R subtests. Bivariate comparison showed that older age (late vocabulary, late similarities, and late object assembly), longer RCP time (early picture arrangement, and early block design), later awake time (early and late picture arrangement, and early block design), longer respirator use (early and late digit span, late picture arrangement), longer ICU time (late picture completion, early and late picture arrangement, and early block design), and longer hospital stay (early picture arrangement) were significantly associated with the decline in neurocognitive performance. Stepwise logistic regression analysis disclosed that older age (late similarities and late object assembly), later awake time (late picture arrangement), and longer respirator use (early and late digit span, and late picture arrangement) were most predictive for the decline in neurocognitive performance.


CONCLUSIONS
On average, digit span, arithmetic, and picture completion tests were most sensitive in detecting the decline in neurocognitive performance. The relationship between the duration of RCP and neurocognitive test results was not significant.
Miyairi
Takeshi
T
Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan. tmiyairi-tky@umin.ac.jp
Takamoto
Shinichi
S
Kotsuka
Yutaka
Y
Takeuchi
Atsuko
A
Yamanaka
Katsuo
K
Sato
Hajime
H
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000517:prevention & control; D003072:Cognition Disorders / Q000517:prevention & control*; D005260:Female; D006323:Heart Arrest; D006324:Heart Arrest, Induced; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011594:Psychometrics; D012039:Regional Blood Flow; D012307:Risk Factors; D014888:Wechsler Scales