Risk Factor Analysis Of Delayed Recovery Of Consciousness After Aortic Arch Surgery

Objective To determine risk factors of delayed recovery of consciousness after aorticarch surgery under deep hypothermic circulatory arrest (DHCA) and antegradeselective cerebral perfusion (ASCP).Methods We retrospectively analyzed clinical data of113patients who underwentaortic arch surgery under DHCA+ASCP in the Affiliated Drum Tower Hospital,Medical School of Nanjing University from October2004to April2012. Accordingto whether they regained consciousness within24hours after surgery, all the113patients were divided into normal group (73patients including55males and18females with their average age of48.1±10.9years) and delayed recovery group(40patients including29males and11females with their average age of52.2±11.4years).Risk factors of delayed recovery of consciousness after surgery were evaluated byunivariate analysis and multivariate logistic regression analysis.Results Nine patients (8.0%) died postoperatively, including5patients withmulti-organ failure,2patients with heart failure,1patient with mediastinal infection,and1patient with pulmonary hemorrhage. There were7deaths (17.5%) in thedelayed recovery group and2deaths (2.7%) in the normal group, and the in-hospitalmortality of the delayed recovery group was significantly higher than that of thenormal group (P=0.016). A total of94patients (including65patients in the normalgroup and29patients in the delayed recovery group) were followed up for4～95months. Eight patients (including5patients in the normal group and3patients in thedelayed recovery group) died during follow-up, including2patients with stroke,3patients with heart failure,2patients with pulmonary hemorrhage and1patient withunknown cause. Ten patients were lost during follow-up. Univariate analysis showed that age (P=0.042), combined with hypertension (P=0.017), emergency surgery(P=0.001), cardiopulmonary bypass (CPB) time (P=0.007), aortic cross-clamp time(P=0.021), and blood transfusion (P=0.012) were risk factors of delayed recovery ofconsciousness after aortic arch surgery. Multivariate logistic regression showed thatemergency surgery (P=0.005) and CPB time>240minutes (P=0.000) wereindependent risk factors of delayed recovery of consciousness after aortic archsurgery.Conclusion Delayed recovery of consciousness after aortic arch surgery is attributedto a combination of many risk factors. Correct patient diagnosis, lesion site andinvolved scope should be made clear preoperatively in order to choose appropriatesurgical strategies. During the surgery, strengthened brain protection, shortenedoperation time, improved surgical techniques, and perioperative stable circulationmaintenance are all important measures to prevent delayed recovery of consciousnessafter aortic arch surgery.