Background  There are many reports about cerebral infarction after arch replacement, but few about neurocognitive function.  This study is aimed to evaluate.

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Presentation transcript:

Background  There are many reports about cerebral infarction after arch replacement, but few about neurocognitive function.  This study is aimed to evaluate neurocognitive outcomes after arch replacement. Purpose

 Patients : 62 cases (elective) TAA 55, Dissection 7  Gender : Male 40, Female 22  Age : 71±8.8 y.o. (34-84)  Concomitant procedures CABG14(23%) AVR 5(8.1%) Bentall 2(3.2%) History of CVD8(13%) Carotid Artery Disease(75% ≦ )6(9.7%) Neurological Dysfunction3(4.8%) Cerebral infarction (MRI)25(40%) Patients Characteristics

Deep-hypothermic circulatory arrest ＆ Selective cerebral perfusion Pump 1 Pump 2 Perfusion pressure 30 ～ 40mmHg 250ml/min 200ml/min Occlusion Balloon or Clamp CPB SCP Deep hypothermia 20 ℃ (Rectum) 14Fr. Catheter 12Fr. Catheter

Operative Results Operation time (min)462±112 CPB time (min)302±80.7 Aortic cross-clamping time (min)186±44.6 Circulatory arrest time (min)82.3±29.2 SCP time (min)133±35.5 Minimum rectal temperature ( ℃ ) 21±1.5 Brachiocepharic artery perfusion pressure (mmHg) 31.8±10 Left carotid artery perfusion pressure (mmHg)41.3±8.5

Methods  4 Tests Hasegawa Dementia Scale Kana-Pick Out Test Digit span Digit symbol test  Test timing Before operation ＆ 7days after operation  Definition of Neurocognitive dysfunction Positive is determined for more than 20% of impairment from pre-operation. Neurocognitive dysfunction is defined as 2 positives of the 4.

Hasegawa Dementia Scale (HDS) General function  Frequently performed dementia scale in Japan  2 tasks in 2 minutes Reading a short story Finding specific letters  Score Number of the letters Kana-Pick Out Test Executive function

Digit Span Attention and Recent memory  Score: Forward + Backward  Score: Number of the correct answers in 90 seconds Digit Symbol Test Attention and Psychomotor speed

Results of 4 Tests Pre-operation (n=53) POD 7th (n=53) P HDS26.7± ± Kana-Pick Out Test19.6± ± Digit span12.2± ± Digit symbol test32.4± ±14.1 ＜ patients : Complete 6 : prolonged ventilation 9 patients : Incomplete 2 : cerebral infarction 1 : other

Neurocognitive Dysfunction HDS Kana Pick- Out Test Digit span Digit symbol test Positive 0 (0%) 21 (40%) 9 (17%) 19 (36%) Neurocognitive dysfunction 16(30%)

Predictors of Neurocognitive Dysfunction No Dysfunction (n=37) Dysfunction (n=16) P Age71±9.772± Gender (male)22 (59%) 10 (62.5%) 0.84 History of CVD6 (16%)2 (13%) 0.73 Neurological dysfunction 1 (2.7%)2 (13%) 0.16 Cerebral infarction (MRI) 17 (46%)6 (38%) 0.57 Carotid Artery Disease 3 (8.1%)2 (13%) 0.62No Dysfunction (n=37) Dysfunction(n=16)P Ope Time 443± ± CPB Time 289± ± Clamp Time 178± ± Arrest Time 76.3± ± SCP Time 124± ± Minimum Temperature 21.2± ±

 On average, 22.5% of the CABG patients had a decline of at least 1 standard deviation in at least two of a total of nine or ten tests 2 months after their operation (P <.0001; 95% confidence interval, 18.7%-26.4%). Van Dijk D et al : J Thorac Cardiovasc Surg 2000;120:632-9  31%(22/71) of the patients after deep hypothermic circulatory arrest had a more than 50% negative change in memory or fine motor function and attention 1 week postoperatively. Ergin MA et al : Ann Thorac Surg 1999;67: Comments

Conclusions  This study shows 30% of patients after arch replacement have neurocognitive dysfunction at the POD7th.  This acute result is acceptable, however follow up for long-term neurocognitive outcomes and its impacts on the QOL are required.