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DOI: 10.1055/s-2007-967316
Predictors of survival and neurological outcome for patients undergoing aortic arch surgery
Objective: To determine factors influencing survival and postoperative neurological outcome for patients undergoing aortic arch surgery.
Methods and materials: Between January 2000 and June 2006, a total of 159 patients (mean age 60.3±13.1 years) underwent surgery for (n=67 patients) type-A dissection or aortic aneurysm (n=92 patients) including the aortic arch. The preoperative hemodynamic status was stable in 143 patients (group 1), unstable (inotropic support, respiratory insufficiency) in 8 patients (group 2), and 6 patients (group 3) required cardiopulmonary resuscitation (CPR). In 72 patients antegrade cerebral perfusion (ACP) with moderate hypothermia was used and deep hypothermia and circulatory arrest (CA) in 87 patients. Graft replacement was done in 112 patients, valve-sparing procedures in 10, composite grafts in 35, and additional coronary artery bypass grafting (CABG) in 26 patients. Perioperative predictors for survival and cerebro-vascular events (CVE) were evaluated by univariate analyses. Mean follow-up by questionnaire after 28±18 months postoperatively.
Results: Overall hospital mortality rate was 11% (group 3: 100%). Thirty-five patients (20%) had CVE. The rate of CVE (17.8% vs. 55.5%, p=0.06) and 30-day mortality (7.74% vs. 33.3%, p=0.009) was significantly lower in group 1 versus group 2. Univariate analysis revealed circulatory arrest (p=0.046 and p=0.015) and type-A dissection (p=0.002 and p=0.001) to be significant risk factors for survival and CVE, respectively. Additional CABG did not influence survival rate.
Conclusion: Preoperative CPR, CA and acute type-A dissection prove to be significant risk factors influencing survival and neurological outcome for patients undergoing aortic arch surgery. Antegrade cerebral perfusion improves the outcome.