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Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring
OBJECTIVE: To explore the prognostic factors for permanent neurological dysfunction (PND) after total aortic arch replacement with regional cerebral oxygen saturation (rSO(2)) monitoring. METHODS: This retrospective study enrolled 98 type A aortic dissection aneurysm patients who underwent emergency...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625482/ https://www.ncbi.nlm.nih.gov/pubmed/31144479 http://dx.doi.org/10.1002/brb3.1309 |
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author | Yu, Ying Lyu, Yi Jin, Lin Xu, Liying Wang, Huilin Hu, Yan Ren, Yun Guo, Kefang |
author_facet | Yu, Ying Lyu, Yi Jin, Lin Xu, Liying Wang, Huilin Hu, Yan Ren, Yun Guo, Kefang |
author_sort | Yu, Ying |
collection | PubMed |
description | OBJECTIVE: To explore the prognostic factors for permanent neurological dysfunction (PND) after total aortic arch replacement with regional cerebral oxygen saturation (rSO(2)) monitoring. METHODS: This retrospective study enrolled 98 type A aortic dissection aneurysm patients who underwent emergency total aortic arch replacement combined with deep hypothermic circulatory arrest and right axillary artery selective antegrade cerebral perfusion (SACP). Data such as age, gender, body mass index, preoperative coexisting disease, laboratory test results, intraoperative critical operation duration, and intraoperative rSO(2) were collected, and the neurological prognoses in the hospital were recorded and grouped by severity. Multiple logistic regression analysis was performed on the statistically significant differences between the groups to screen the predictors of postoperative neurological complications in these patients. RESULTS: Forty‐two patients had postoperative neurological complications, among which there were 29 cases (29.6%) of transient neurological dysfunction, and 13 cases (13.3%) of PND. Multiple logistic regression results showed that advanced age, preoperative low platelet count, prolonged hemostasis time and lowest relative rSO(2) to baseline (ΔrSO(2)min) in each time period were risk factors for postoperative PND. The ROC curve measurement showed that the optimal cut‐off value of ΔrSO(2)min was 79.7%, and the area under the curve was 0.708 (95% confidence interval = 0.557–0.858), p = 0.016; the optimal cut‐off value of ΔrSO(2)min in SACP was 81.6%, and the area under the curve was 0.720 (95% confidence interval = 0.570–0.870), p = 0.011; the optimal cut‐off value of ΔrSO(2)min in cardiopulmonary bypass (CPB) was 80.8%, and the area under the curve was 0.697 (95% confidence interval = 0.554–0.840), p = 0.023. CONCLUSION: Intraoperative ΔrSO(2)min that is lower than the basal level of about 80%, advanced age, preoperative low platelet count, and prolonged hemostasis time are predictors of PND after total aortic arch replacement. |
format | Online Article Text |
id | pubmed-6625482 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-66254822019-07-17 Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring Yu, Ying Lyu, Yi Jin, Lin Xu, Liying Wang, Huilin Hu, Yan Ren, Yun Guo, Kefang Brain Behav Original Research OBJECTIVE: To explore the prognostic factors for permanent neurological dysfunction (PND) after total aortic arch replacement with regional cerebral oxygen saturation (rSO(2)) monitoring. METHODS: This retrospective study enrolled 98 type A aortic dissection aneurysm patients who underwent emergency total aortic arch replacement combined with deep hypothermic circulatory arrest and right axillary artery selective antegrade cerebral perfusion (SACP). Data such as age, gender, body mass index, preoperative coexisting disease, laboratory test results, intraoperative critical operation duration, and intraoperative rSO(2) were collected, and the neurological prognoses in the hospital were recorded and grouped by severity. Multiple logistic regression analysis was performed on the statistically significant differences between the groups to screen the predictors of postoperative neurological complications in these patients. RESULTS: Forty‐two patients had postoperative neurological complications, among which there were 29 cases (29.6%) of transient neurological dysfunction, and 13 cases (13.3%) of PND. Multiple logistic regression results showed that advanced age, preoperative low platelet count, prolonged hemostasis time and lowest relative rSO(2) to baseline (ΔrSO(2)min) in each time period were risk factors for postoperative PND. The ROC curve measurement showed that the optimal cut‐off value of ΔrSO(2)min was 79.7%, and the area under the curve was 0.708 (95% confidence interval = 0.557–0.858), p = 0.016; the optimal cut‐off value of ΔrSO(2)min in SACP was 81.6%, and the area under the curve was 0.720 (95% confidence interval = 0.570–0.870), p = 0.011; the optimal cut‐off value of ΔrSO(2)min in cardiopulmonary bypass (CPB) was 80.8%, and the area under the curve was 0.697 (95% confidence interval = 0.554–0.840), p = 0.023. CONCLUSION: Intraoperative ΔrSO(2)min that is lower than the basal level of about 80%, advanced age, preoperative low platelet count, and prolonged hemostasis time are predictors of PND after total aortic arch replacement. John Wiley and Sons Inc. 2019-05-29 /pmc/articles/PMC6625482/ /pubmed/31144479 http://dx.doi.org/10.1002/brb3.1309 Text en © 2019 The Authors. Brain and Behavior published by Wiley Periodicals, Inc. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Research Yu, Ying Lyu, Yi Jin, Lin Xu, Liying Wang, Huilin Hu, Yan Ren, Yun Guo, Kefang Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title | Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title_full | Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title_fullStr | Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title_full_unstemmed | Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title_short | Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
title_sort | prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625482/ https://www.ncbi.nlm.nih.gov/pubmed/31144479 http://dx.doi.org/10.1002/brb3.1309 |
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