Risk Factors Of Death And Complications In Aortic Arch Replacement Under Deep Hypothermic Circulatory Arrest Surgery

Background:Aortic disease is on the rising in China in recent years. Traditional surgery is the most effective therapy to the aortic arch disease. Surgery for aortic arch disease itself is complex and is usually performed under condition of deep hypothermic and circulatory arrest. Therefore it is complicated with a high mortality and morbidity. There is not much study of risk factor analysis to death and complications of this procedure. The purpose of this study was to identify risk factors of postoperative severe adverse outcome (all-cause in hospital death and permanent neurological dysfunction), temporary neurological dysfunction and acute renal failure.Methods:Data of patients receiving aortic arch replacement under deep hypothermic circulatory arrest between January2005and June2011were retrospectively analyzed. Those patients underwent one-stage total or subtotal aortic replacement were excluded. Univariate and multivariate logistic regression analysis were used to identify the risk factors for severe adverse outcome (hospital death and permanent neurological dysfunctions), temporary neurological dysfunction and acute renal failure.Results:The study included549cases. Severe adverse outcome occurred in32cases (5.8%), which included22cases (4.0%) of death and12cases (2.2%) of permanent neurological dysfunction. Temporary neurological dysfunction occurred in83cases (15.1%). Acute renal failure occurred in102cases (18.6%). Multiple logistic regression showed age (OR1.069, P=0.011), history of stroke (OR3.816, P=0.031), preoperative WBC (OR1.154, P=0.001) and cardiopulmonary bypass time (OR1.009, P=0.001) were independent risk factors of severe adverse outcome. Preoperative WBC (OR1.175, P=0.000), serum creatinine level (OR1.013, P=0.001), low-flow perfusion time (OR1.041, P=0.031) and peak intraoperative glucose level (OR1.013, P=0.000) were independent risk factors of temporary neurological dysfunction. Body mass index(OR1.072,P=0.031), serum creatinine level (OR1.011,P=0.000), cardiopulmonary bypass time (OR1.006,P=0.005) and peak intraoperative glucose level (OR1.007,,P=0.003) were independent risk factors of acute renal failure. Areas under receiver operating characteristic curve of WBC to adverse outcome and temporary neurological dysfunction was0.70(P=0.000) and0.72(P=0.000) respectively. The patients were divided into four groups by the quartile of peak intraoperative glucose level, and patients with peak intraoperative glucose level over240mg/dl had a higher incidence of temporary neurological dysfunction (OR2.451, P=0.003) and acute renal failure (OR1.923, P=0.015). Body mass index, acute aortic dissection, diabetes and low-flow time were independently related to peak intraoperative glucose level over240mg/dl.Conclusions:Age, history of stroke, preoperative white cell count, cardiopulmonary bypass time were independent risk factors of death and permanent neurological dysfunction. Preoperative white cell count, preoperative serum creatinine level, low-flow time were independent risk factors of temporary neurological dysfunction. Body mass index, preoperative serum creatinine level, cardiopulmonary bypass time and peak intraoperative glucose level were independent risk factors of acute renal failure. Preoperative white cell count was related to severe adverse outcome (death and permanent neurological dysfunction), temporary neurological dysfunction and acute renal failure. Peak glucose level over240mg/dl is a predictor of temporary neurological dysfunction and acute failure. Preoperative WBC and intraoperative hyperglycemia can as markers of operation risk.