Neuropsychologic Outcome after Aortic Arch Surgery: Effects of a Selective Cerebral Perfusion Technique under Deep Hypothermic Circulatory Arrest

(Department of Surgery, Kurume University School of Medicine, Kurume, Japan)

Teiji Okazaki
To determine the effects of a selective cerebral perfusion (SCP) technique under deep hypothermic circulatory arrest (DHCA) for aortic arch surgery, the neuropsychological outcomes of 38 patients with cardiovascular disease were examined before and after the operation. Thirteen patients undergoing aortic arch repair with SCP under DHCA (SCP group) were evaluated with 2 batteries of neuropsychological tests (Benton Visual Retention Test and Miyakefs Verbal Memory Test) resulting in 4 subscores, and the results were compared with those of 15 heart surgery patients who underwent a normal cardiopulmonary bypass (CPB group) and 10 patients who underwent abdominal aortic aneurysm repair without CPB (Y group). There were no significant differences in age, incidence of preoperative cerebrovascular complications, or mean score on the preoperative neuropsychological tests among the groups. In the postoperative period, the patients in all 3 groups performed less well than they did preoperatively on 3 of 4 subscores, however, there were no differences among the 3 groups. On 1 of 3 subscores, the postoperative mean score in the SCP group was significantly lower than the preoperative and postoperative mean scores in the Y group, whereas there were no differences between the SCP and CPB groups. In the SCP group, the patients whose postoperative mean score was lower than the preoperative score had longer SCP times than the patients without a lower postoperative mean score. In conclusion, CPB, including SCP, may be a risk factor for the deterioration of postoperative neuropsychological function, although each group had deteriorated test scores in the early postoperative phase and the severity of the deterioration was not exceedingly high using our SCP methods. Various factors, such as drugs, anesthesia, surgical technique, and physical and psychological damage are believed to potentially have an effect on deteriorated postoperative neuropsychological function.
@Jpn. J. Cardiovasc. Surg. 33: 244-251 (2004)