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Perioperative cerebral perfusion in aortic arch surgery: a potential link with neurological outcome

Weijs, RWJ, Tromp, SC, Heijmen, RH, Seeber, AA, van Belle-VanHaaren, NJCW, Claassen, JAHR and Thijssen, DHJ (2023) Perioperative cerebral perfusion in aortic arch surgery: a potential link with neurological outcome. European Journal of Cardio-Thoracic Surgery, 63 (6). ezad144. ISSN 1010-7940

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OBJECTIVES: The aim of this study was to examine whether perioperative changes in cerebral blood flow (CBF) relate to postoperative neurological deficits in patients undergoing aortic arch surgery involving antegrade selective cerebral perfusion (ASCP). METHODS: We retrospectively analysed data from patients who underwent aortic arch surgery involving ASCP and perioperative transcranial Doppler assessments. Linear mixed-model analyses were performed to examine perioperative changes in mean bilateral blood velocity in the middle cerebral arteries, reflecting changes in CBF, and their relation with neurological deficits, i.e. ischaemic stroke and/or delirium. Logistic regression analyses were performed to explore possible risk factors for postoperative neurological deficits. RESULTS: In our study population (N = 102), intraoperative blood velocities were lower compared to preoperative levels, and lowest during ASCP. Thirty-six (35%) patients with postoperative neurological deficits (ischaemic stroke, n = 9; delirium, n = 25; both, n = 2) had lower blood velocity during ASCP compared to patients without (25.4 vs 37.0 cm/s; P = 0.002). Logistic regression analyses revealed lower blood velocity during ASCP as an independent risk factor for postoperative neurological deficits (odds ratio = 0.959; 95% confidence interval: 0.923, 0.997; P = 0.037). CONCLUSIONS: Lower intraoperative CBF during ASCP seems independently related to postoperative neurological deficits in patients undergoing aortic arch surgery. Because CBF is a modifiable factor during ASCP, our observation has significant potential to improve clinical management and prevent neurological deficits.

Item Type: Article
Uncontrolled Keywords: Aorta, Thoracic; Humans; Brain Ischemia; Delirium; Aortic Aneurysm, Thoracic; Postoperative Complications; Treatment Outcome; Retrospective Studies; Perfusion; Cerebrovascular Circulation; Stroke; Ischemic Stroke; Antegrade selective cerebral perfusion; Aortic surgery; Cerebral circulation; Perioperative management; Postoperative complication; Thoracic aorta; Humans; Aorta, Thoracic; Brain Ischemia; Retrospective Studies; Stroke; Perfusion; Ischemic Stroke; Cerebrovascular Circulation; Delirium; Treatment Outcome; Postoperative Complications; Aortic Aneurysm, Thoracic; 1102 Cardiorespiratory Medicine and Haematology; Respiratory System
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RD Surgery
Divisions: Sport & Exercise Sciences
Publisher: Oxford University Press
SWORD Depositor: A Symplectic
Date Deposited: 07 Nov 2023 12:13
Last Modified: 07 Nov 2023 12:15
DOI or ID number: 10.1093/ejcts/ezad144
URI: https://researchonline.ljmu.ac.uk/id/eprint/21808
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