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Journal of Cardiothoracic Surgery

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Open Access 01-12-2019 | Circulatory Arrest | Research article

The risk factors for postoperative cerebral complications in patients with Stanford type a aortic dissection

Authors: Yong Lin, Mei-Fang Chen, Hui Zhang, Ruo-Meng Li, Liang-Wan Chen

Published in: Journal of Cardiothoracic Surgery | Issue 1/2019

Abstract

Background

Postoperative cerebral complications (PCC) are common and serious postoperative complications for patients with Stanford type A aortic dissection (AAD). The aim of this study was to evaluate the risk factors for PCC in these patients and to provide a scientific basis for effective prevention of PCC.

Methods

In this retrospective case-control study, 125 patients with AAD who underwent thoracotomy in our department from October 2017 to October 2018 in the department of cardiovascular surgery, Fujian Medical University Union Hospital were divided into two groups: patients with PCC (n = 12), and patients without PCC (n = 113). The general clinical data, the types of corrective surgeries, the intraoperative situations, the postoperative complications, and the midterm outcomes of the patients were analyzed.

Results

The patients with PCC were significantly older than the patients without PCC (P = 0.016), and the incidence of the preoperative cerebral disease history in the patients with PCC was significantly higher than those of the PCC (−) group (P = 0.024). The Euro SCORE II of patients with PCC was dramatically higher than the patients without PCC (P = 0.005). There were significant differences between the two groups in terms of the duration of cardiopulmonary bypass (CPB) (P = 0.010) and the length of moderate hypothermic circulatory arrest (MHCA) combined with selective cerebral perfusion (SCP) (P = 0.000). The monitoring of rcSO₂ indicated that there was significant difference between the two groups in terms of the bilateral baseline (P = 0.000). Patients with PCC were observed to have experienced significantly longer intubation times (P = 0.000), ICU stays (P = 0.001), and postoperative hospital stays (P = 0.009), and they also had dramatically higher rates of pulmonary infection (P = 0.000), multiple organ dysfunction syndrome (P = 0.041) and tracheotomy (P = 0.022) after surgeries. The duration of MHCA+SCP (OR:9.009, P = 0.034) and the average baseline value of rcSO₂ (OR:0.080, P = 0.009) were ultimately identified as significant risk factors.

Conclusions

PCC has a serious influence on the prognoses of patients following surgical treatment with AAD. The duration of MHCA+SCP and the average baseline value of rcSO₂ were the independent risk factors for PCC.

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Title: The risk factors for postoperative cerebral complications in patients with Stanford type a aortic dissection
Authors: Yong Lin
Mei-Fang Chen
Hui Zhang
Ruo-Meng Li
Liang-Wan Chen
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Circulatory Arrest
Aortic Dissection
Published in: Journal of Cardiothoracic Surgery / Issue 1/2019
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-019-1009-5

At a glance: The STEP trials

Springer Medicine

The risk factors for postoperative cerebral complications in patients with Stanford type a aortic dissection

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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