Predictors of adverse outcome and transient neurological dysfunction afterascending aorta/hemiarch replacement

Background. This study was undertaken to determine predictors of adverse ou tcome and transient neurological dysfunction after replacement of the ascen ding aorta with an open distal anastomosis. Methods. All 443 patients (300 male, median age 63) undergoing replacement of the ascending aorta with an open distal anastomosis between 1986 and 199 8 were included in the analysis. The ascending aorta alone was replaced in 190 (42.9%); 253 (57.1%) also had proximal arch replacement. Median hypothe rmic circulatory arrest (HCA) time was 25 minutes (range 12 to 68). Either death or permanent neurological dysfunction were considered adverse outcome (AO). Results. Adverse outcome occurred in 11.5% (51 of 443) of patients overall: in 7.4% of elective (20 of 269) or urgent (4 of 54) operations, but in 17% (19 of 113) of emergencies. Multivariate analysis of the group as a whole revealed that significant (p < 0.05) independent preoperative predictors of AO were age greater than 60 [odds ratio (OR) 2.2], hemodynamic instability (OR 2.7), and dissection (OR 1.9). For the 435 operative survivors, proced ural variables predictive of AO were contained rupture (OR 2.8) and HCA tim e (OR 1.03/min). When only the 271 elective patients were analyzed separate ly, the need for a concomitant procedure (p = 0.009, OR 3.6) and HCA time ( p = 0.002, OR 1.06/min) were the only predictors of AO in multivariate anal ysis. Transient neurological dysfunction (TND) occurred in 86 of 392 patien ts (22%). Significant predictors of TND for all patients without AO were ag e (OR 1.06/y), HCA time (OR 1.04/min), coronary artery disease (OR 2.2), he modynamic instability (OR 3.4), and acute operation (OR 2.2). Survival of d ischarged patients was 93% at I year and 83% at 5 years. Conclusions. Early elective operation and shorter HCA time during ascending aorta/hemiarch surgery will reduce both AO and TND. (C) 2000 by The Societ y of Thoracic Surgeons.