Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring
Abstract Objective To explore the prognostic factors for permanent neurological dysfunction (PND) after total aortic arch replacement with regional cerebral oxygen saturation (rSO2) monitoring. Methods This retrospective study enrolled 98 type A aortic dissection aneurysm patients who underwent emer...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Wiley
2019-07-01
|
Series: | Brain and Behavior |
Subjects: | |
Online Access: | https://doi.org/10.1002/brb3.1309 |
id |
doaj-461b3182a16d43d3b9d5fc87b08ba349 |
---|---|
record_format |
Article |
spelling |
doaj-461b3182a16d43d3b9d5fc87b08ba3492020-11-25T03:48:04ZengWileyBrain and Behavior2162-32792019-07-0197n/an/a10.1002/brb3.1309Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoringYing Yu0Yi Lyu1Lin Jin2Liying Xu3Huilin Wang4Yan Hu5Yun Ren6Kefang Guo7Department of Anesthesiology Zhongshan Hospital, Fudan University Shanghai ChinaDepartment of Anesthesiology Yunnan Baoshan Anli Hospital Baoshan ChinaDepartment of Anesthesiology Zhongshan Hospital, Fudan University Shanghai ChinaDepartment of Anesthesiology Zhongshan Hospital, Fudan University Shanghai ChinaDepartment of Anesthesiology Zhongshan Hospital, Fudan University Shanghai ChinaDepartment of Anesthesiology Zhongshan Hospital, Fudan University Shanghai ChinaDepartment of Anesthesiology Zhongshan Hospital, Fudan University Shanghai ChinaDepartment of Anesthesiology Zhongshan Hospital, Fudan University Shanghai ChinaAbstract Objective To explore the prognostic factors for permanent neurological dysfunction (PND) after total aortic arch replacement with regional cerebral oxygen saturation (rSO2) monitoring. Methods This retrospective study enrolled 98 type A aortic dissection aneurysm patients who underwent emergency total aortic arch replacement combined with deep hypothermic circulatory arrest and right axillary artery selective antegrade cerebral perfusion (SACP). Data such as age, gender, body mass index, preoperative coexisting disease, laboratory test results, intraoperative critical operation duration, and intraoperative rSO2 were collected, and the neurological prognoses in the hospital were recorded and grouped by severity. Multiple logistic regression analysis was performed on the statistically significant differences between the groups to screen the predictors of postoperative neurological complications in these patients. Results Forty‐two patients had postoperative neurological complications, among which there were 29 cases (29.6%) of transient neurological dysfunction, and 13 cases (13.3%) of PND. Multiple logistic regression results showed that advanced age, preoperative low platelet count, prolonged hemostasis time and lowest relative rSO2 to baseline (ΔrSO2min) in each time period were risk factors for postoperative PND. The ROC curve measurement showed that the optimal cut‐off value of ΔrSO2min was 79.7%, and the area under the curve was 0.708 (95% confidence interval = 0.557–0.858), p = 0.016; the optimal cut‐off value of ΔrSO2min in SACP was 81.6%, and the area under the curve was 0.720 (95% confidence interval = 0.570–0.870), p = 0.011; the optimal cut‐off value of ΔrSO2min in cardiopulmonary bypass (CPB) was 80.8%, and the area under the curve was 0.697 (95% confidence interval = 0.554–0.840), p = 0.023. Conclusion Intraoperative ΔrSO2min that is lower than the basal level of about 80%, advanced age, preoperative low platelet count, and prolonged hemostasis time are predictors of PND after total aortic arch replacement.https://doi.org/10.1002/brb3.1309deep hypothermic circulatory arrestpermanent neurological dysfunctionprognostic factorsregional cerebral oxygen saturation monitoringtotal aortic arch replacement |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ying Yu Yi Lyu Lin Jin Liying Xu Huilin Wang Yan Hu Yun Ren Kefang Guo |
spellingShingle |
Ying Yu Yi Lyu Lin Jin Liying Xu Huilin Wang Yan Hu Yun Ren Kefang Guo Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring Brain and Behavior deep hypothermic circulatory arrest permanent neurological dysfunction prognostic factors regional cerebral oxygen saturation monitoring total aortic arch replacement |
author_facet |
Ying Yu Yi Lyu Lin Jin Liying Xu Huilin Wang Yan Hu Yun Ren Kefang Guo |
author_sort |
Ying Yu |
title |
Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title_short |
Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title_full |
Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title_fullStr |
Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title_full_unstemmed |
Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title_sort |
prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
publisher |
Wiley |
series |
Brain and Behavior |
issn |
2162-3279 |
publishDate |
2019-07-01 |
description |
Abstract Objective To explore the prognostic factors for permanent neurological dysfunction (PND) after total aortic arch replacement with regional cerebral oxygen saturation (rSO2) monitoring. Methods This retrospective study enrolled 98 type A aortic dissection aneurysm patients who underwent emergency total aortic arch replacement combined with deep hypothermic circulatory arrest and right axillary artery selective antegrade cerebral perfusion (SACP). Data such as age, gender, body mass index, preoperative coexisting disease, laboratory test results, intraoperative critical operation duration, and intraoperative rSO2 were collected, and the neurological prognoses in the hospital were recorded and grouped by severity. Multiple logistic regression analysis was performed on the statistically significant differences between the groups to screen the predictors of postoperative neurological complications in these patients. Results Forty‐two patients had postoperative neurological complications, among which there were 29 cases (29.6%) of transient neurological dysfunction, and 13 cases (13.3%) of PND. Multiple logistic regression results showed that advanced age, preoperative low platelet count, prolonged hemostasis time and lowest relative rSO2 to baseline (ΔrSO2min) in each time period were risk factors for postoperative PND. The ROC curve measurement showed that the optimal cut‐off value of ΔrSO2min was 79.7%, and the area under the curve was 0.708 (95% confidence interval = 0.557–0.858), p = 0.016; the optimal cut‐off value of ΔrSO2min in SACP was 81.6%, and the area under the curve was 0.720 (95% confidence interval = 0.570–0.870), p = 0.011; the optimal cut‐off value of ΔrSO2min in cardiopulmonary bypass (CPB) was 80.8%, and the area under the curve was 0.697 (95% confidence interval = 0.554–0.840), p = 0.023. Conclusion Intraoperative ΔrSO2min that is lower than the basal level of about 80%, advanced age, preoperative low platelet count, and prolonged hemostasis time are predictors of PND after total aortic arch replacement. |
topic |
deep hypothermic circulatory arrest permanent neurological dysfunction prognostic factors regional cerebral oxygen saturation monitoring total aortic arch replacement |
url |
https://doi.org/10.1002/brb3.1309 |
work_keys_str_mv |
AT yingyu prognosticfactorsforpermanentneurologicaldysfunctionaftertotalaorticarchreplacementwithregionalcerebraloxygensaturationmonitoring AT yilyu prognosticfactorsforpermanentneurologicaldysfunctionaftertotalaorticarchreplacementwithregionalcerebraloxygensaturationmonitoring AT linjin prognosticfactorsforpermanentneurologicaldysfunctionaftertotalaorticarchreplacementwithregionalcerebraloxygensaturationmonitoring AT liyingxu prognosticfactorsforpermanentneurologicaldysfunctionaftertotalaorticarchreplacementwithregionalcerebraloxygensaturationmonitoring AT huilinwang prognosticfactorsforpermanentneurologicaldysfunctionaftertotalaorticarchreplacementwithregionalcerebraloxygensaturationmonitoring AT yanhu prognosticfactorsforpermanentneurologicaldysfunctionaftertotalaorticarchreplacementwithregionalcerebraloxygensaturationmonitoring AT yunren prognosticfactorsforpermanentneurologicaldysfunctionaftertotalaorticarchreplacementwithregionalcerebraloxygensaturationmonitoring AT kefangguo prognosticfactorsforpermanentneurologicaldysfunctionaftertotalaorticarchreplacementwithregionalcerebraloxygensaturationmonitoring |
_version_ |
1724500438611394560 |