Predictor of neurologic dysfunction after elective thoracic aorta repair using selective cerebral perfusion.
OBJECTIVE
This study was undertaken to determine the factors that influence postoperative neurological dysfunction after selective cerebral perfusion (SCP).


METHODS
From 1995 to August 2004, 60 patients were evaluated for the presence of cerebro-vascular disease (CVD), and then underwent thoracic aortic operations using SCP. Perioperative factors were evaluated by multivariate analyses.


RESULTS
Hospital mortality rate was zero. Sixteen patients (26.7%) proved to have CVD. Permanent neurological dysfunction (PND) appeared in three patients (5.0%) and transient neurological dysfunction (TND) in two (3.3%). Univariate analysis revealed superficial temporal artery (STA) pressure during SCP (p = 0.0410) to be a significant risk factor for PND. Variables that achieved values of p < 0.2 (aortic cross-clamp time, presence of CVD, old cerebral infarction, presence of clots or atheroma) were examined with multivariate analysis and the presence of CVD (p = 0.038) and STA pressure during SCP (p = 0.032) were independent risk factors for PND. Multivariate analysis for TND did not show any risk factor.


CONCLUSIONS
The presence of CVD was indicated as an independent risk factor for PND after thoracic aortic operations using SCP.
Nakamura
Kunihide
K
The Department of Surgery 2, Miyazaki Medical College, University of Miyazaki, Miyazaki, Japan. shiori@med.miyazaki-u.ac.jp
Onitsuka
Toshio
T
Yano
Mitsuhiro
M
Yano
Yoshikazu
Y
Saitoh
Tomokazu
T
Kojima
Kazushi
K
Furukawa
Koji
K
D000368:Aged; D000792:Angiography / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D002545:Brain Ischemia / Q000517:prevention & control*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010477:Perfusion; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods