Impact of Deep Hypothermic Circulatory Arrest with Antegrade Cerebral Perfusion on Cognitive Function_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QINWei , HUANGFu-hua ,  CHENXin , XIAOLi-qiong , SHIHong-wei , XUMing , WANGLi-ming

Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, P. R. China;

Corresponding?author：

CHENXin, Email: stevecx@sina.com

Keywords：

Deep hypothermic circulatory arrest; Antegrade cerebral perfusion; Aortic dissection; Cognitive function; Mini-mental status examination

DOI：

10.7507/1007-4848.20140019

Video：

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Objective To investigate the impact of deep hypothermic circulatory arrest (DHCA) with antegrade cerebral perfusion (ACP) on cognitive function of patients undergoing surgical therapy for acute Stanford type A aortic dissection (AD). Methods Between January 2009 and March 2012, 48 patients with acute Stanford type A AD underwent Sun's procedure (aortic arch replacement combined with stented elephant trunk implantation) under DHCA with ACP in Nanjing Hospital affiliated to Nanjing Medical University. There were 40 males and 8 females with their age of 51.3±13.6 years. Circulatory arrest time and time for postoperative consciousness recovery were recorded. Preoperative and postoperative cognitive functions of each patient were evaluated by mini-mental status examination (MMSE). Results Mean cardiopulmonary bypass time of the 48 patients was 237.3±58.5 minutes, and mean circulatory arrest time was 37.3 ±6.9 minutes. Four patients died postoperatively with the causes of death including lung infection, multiple organ dysfunction syndrome, myocardial infarction and acute respiratory distress syndrome. Forty-one patients recovered their consciousness within 24 hours postoperatively, and the mean time for postoperative consciousness recovery was 15.3±6.5 hours. Preoperative MMSE score was 28.6±1.1 points, and MMSE score at 1 week postoperatively was 23.6±4.5 points. Thirty-one patients were followed up for 6 months with the follow-up rate of 70.45%. The average MMSE score of the 31 patients at 6 months after surgery was 27.6±2.1 points which was significantly higher than postoperative average MMSE score (P < 0.05), but not statistically different from preoperative average MMSE score (P > 0.05). Conclusions DHCA with ACP can provide satisfactory cerebral protection for patients undergoing surgical therapy for acute Stanford type A AD, but patients' cognitive function may be adversely affected in the short term. As long as cerebral infarction or hemorrhage is excluded in CT scan of the brain, such adverse impact may generally disappear automatically within 6 months after surgery.

Citation： QINWei, HUANGFu-hua, CHENXin, XIAOLi-qiong, SHIHong-wei, XUMing, WANGLi-ming. Impact of Deep Hypothermic Circulatory Arrest with Antegrade Cerebral Perfusion on Cognitive Function. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 71-74. doi: 10.7507/1007-4848.20140019 Copy

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5.	陳鑫, 黃福華, 徐明, 等.孫氏手術治療急性Stanford A型主動脈夾層.中華胸心血管外科雜志, 2012, 28 (6):333-335.
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10.	Ueda Y.What is the best method for brain protection in surgery of the aortic arch? Retrograde cerebral perfusion.Cardiol Clin, 2010, 28 (2):371-379.
11.	Harrington DK, Ranasinghe AM, Shah A, et al.recommendations for haemodynamic and neurological monitoring in repair of acute type a aortic dissection.Anesthesiol Res Pract, 2011, 2011:949034.
12.	孫立忠, 劉永民, 楊天宇, 等.右鎖骨下動脈插管體外循環技術的臨床應用.中華胸心血管外科雜志, 2000, 16 (2):68-70.
13.	王軍, 徐志云, 鄒良建, 等.主動脈弓部手術腦保護效果臨床分析.中國體外循環雜志, 2008, 6 (2):90-93.
14.	李舜偉.認知功能障礙的診斷與治療.中國神經精神疾病雜志, 2006, 32 (2):189-191.
15.	Ta?demir O, Sarita? A, Kü?üker S, et al.Aortic arch repair with right brachial artery perfusion.Ann Thorac Surg, 2002, 73 (6):1837-1842.
16.	田良鑫, 孫立忠, 程衛平, 等.單側與雙側順行性腦灌注對認知能力的影響.中國胸心血管外科臨床雜志, 2005, 12 (1):8-10.
17.	孫立忠, 田良鑫, 程衛平, 等.單側與雙側順行性腦灌注的前瞻性隨機對照研究.中華胸心血管外科雜志, 2005, 21 (3):154-156.

1. Monk TG, Price CC.Postoperative cognitive disorders.Curr Opin Crit Care, 2011, 17 (4):376-381.
2. Burkhart CS, Steiner LA.Can postoperative cognitive dysfunction be avoided? Hosp Pract (Minneap), 2012, 40 (1):214-223.
3. Haldenwang PL, Wahlers T, Himmels A, et al.Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients Eur J Cardiothorac Surg, 2012, 42 (5):115-120.
4. Conzelmann LO, Hoffmann I, Blettner M, et al.Analysis of risk factors for neurological dysfunction in patients with acute aortic dissection type A:data from the German Registry for Acute Aortic Dissection type A (GERAADA).Eur J Cardiothorac Surg, 2012, 42 (3):557-565.
5. 陳鑫, 黃福華, 徐明, 等.孫氏手術治療急性Stanford A型主動脈夾層.中華胸心血管外科雜志, 2012, 28 (6):333-335.
6. 陶登順, 王輝山, 姜輝, 等.DeBakey I型主動脈夾層的外科治療.中國胸心血管外科臨床雜志, 2011, 18 (3):218-221.
7. 孫立忠, 劉志剛, 常謙, 等.主動脈弓替換加支架"象鼻"手術治療Stanford A型主動脈夾層.中華外科雜志, 2004, 42 (13):812-816.
8. Liu ZG, Sun LZ, Chang Q, et al.Should the "elephant trunk" be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection.J Thorac Cardiovasc Surg, 2006, 131 (1):107-113.
9. Gega A, Rizzo JA, Johnson MH, et al.Straight deep hypothermic arrest:experience in 394 patients supports its effectiveness as a sole means of brain preservation.Ann Thorac Surg, 2007, 84 (3):759-766.
10. Ueda Y.What is the best method for brain protection in surgery of the aortic arch? Retrograde cerebral perfusion.Cardiol Clin, 2010, 28 (2):371-379.
11. Harrington DK, Ranasinghe AM, Shah A, et al.recommendations for haemodynamic and neurological monitoring in repair of acute type a aortic dissection.Anesthesiol Res Pract, 2011, 2011:949034.
12. 孫立忠, 劉永民, 楊天宇, 等.右鎖骨下動脈插管體外循環技術的臨床應用.中華胸心血管外科雜志, 2000, 16 (2):68-70.
13. 王軍, 徐志云, 鄒良建, 等.主動脈弓部手術腦保護效果臨床分析.中國體外循環雜志, 2008, 6 (2):90-93.
14. 李舜偉.認知功能障礙的診斷與治療.中國神經精神疾病雜志, 2006, 32 (2):189-191.
15. Ta?demir O, Sarita? A, Kü?üker S, et al.Aortic arch repair with right brachial artery perfusion.Ann Thorac Surg, 2002, 73 (6):1837-1842.
16. 田良鑫, 孫立忠, 程衛平, 等.單側與雙側順行性腦灌注對認知能力的影響.中國胸心血管外科臨床雜志, 2005, 12 (1):8-10.
17. 孫立忠, 田良鑫, 程衛平, 等.單側與雙側順行性腦灌注的前瞻性隨機對照研究.中華胸心血管外科雜志, 2005, 21 (3):154-156.

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Impact of Deep Hypothermic Circulatory Arrest with Antegrade Cerebral Perfusion on Cognitive Function

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