The incidence, risk factors and outcomes of impaired cerebral autoregulation in aortic arch surgery: a single-center, retrospective cohort study

BACKGROUND: Impairment of cerebral autoregulation (CA) has been observed in patients undergoing cardiopulmonary bypass (CPB), but little is known about its risks and associations with outcomes. The cerebral oximetry index (COx), which is a moving linear correlation coefficient between regional cerebral oxygen saturation (rScO(2)) and mean blood pressure (MAP), may reflect CA function. When COx approaches 1, it implies that CA is damaged, whereas the CA is functional when the COx value approaches 0. The objective of this study was to analyze the incidence and risks of impaired CA, based on COx assessment, in patients undergoing total aortic arch replacement under systemic moderate hypothermia and circulatory arrest of the lower body (MHCA). We also evaluated the association between impaired CA and patient outcomes. METHODS: One hundred and fifty-four adult patients who underwent total aortic arch replacement with stented elephant trunk implantation under MHCA at our hospital were retrospectively analyzed. Patients were defined as having new-onset impaired CA if pre-CPB COx < 0.3 and post-CPB COx > 0.3. Pre- and intraoperative factors were tested for independent association with impaired CA. Postoperative outcomes were compared between patients with normal and impaired CA. RESULTS: In our 154 patients, 46(29.9%) developed new-onset impaired CA after CPB. Multivariable analysis revealed a prolonged low rScO(2) (rScO(2) < 55%) independently associated with onset of impaired CA, and receiver operating charactoristic curve showed a cutoff value at 40 min (sensitivity, 89.5%; specificity, 68.0%). Compared with normal CA patients, those with impaired CA showed a significantly higher rates of in-hospital mortality and postoperative complications. CONCLUSIONS: Prolonged low rScO(2) (rScO(2) < 55%) during aortic arch surgery was closely related to onset of impaired CA. Impaired CA remained associated with the increased rates of postoperative complications and in-hospital mortality. TRIAL REGISTRATION: ChiCTR1800014545 with registered date 20/01/2018.