Neurologic complications after deep hypothermic circulatory arrest - Types, predictors, and timing

To determine the nature of neurologic dysfunction after deep hypothermic ci rculatory arrest during aortic arch surgery, we reconsidered the cases of 1 54 patients who had undergone aortic arch surgery (either of the ascending or transverse aorta, or both) between November 1993 and July 1999. Temporar y postoperative neurologic dysfunction was seen in 9 patients (5.8%), and a nother 3 patients (1.9%) experienced stroke. Patients with temporary neurol ogic dysfunction had no new infarct and were discharged home with no residu al symptoms. Computed tomographic scans revealed hat 2 patients with stroke had multiple infarcts in the brainstem, and the 3rd had bilateral border-z one infarcts. The patients with brainstem infarcts died on postoperative da ys 7 and 15, and he patient with border-zone infarct was discharged home wi th no symptoms 3 months after surgery. Univariate analysis revealed that patients with neurologic deficits had sig nificantly higher rates of history of hypertension, concomitant coronary ar tery bypass grafting, cardiac ischemia times longer than 90 minutes, and ch ronic renal failure. A multivariale logistic regression analysis revealed t hat the significant preoperative variables associated with neurologic defic its were a history of hypertension and a cardiac ischemia time longer than 90 minutes. Deep hypothermic circulatory arrest is a safe and useful technique for prot ection of he brain during surgery for complex aortic problems. in future, s ome patients at extreme risk for perioperative neurologic complications mig ht be offered novel neuroprotective agents, in combination with deep hypoth ermia.