Neuropsychologic Outcome after
Aortic Arch Surgery: Effects of a Selective Cerebral Perfusion
Technique under Deep Hypothermic Circulatory Arrest |
(Department of Surgery, Kurume University School
of Medicine, Kurume, Japan)
Teiji Okazaki |
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To determine the effects of a selective
cerebral perfusion (SCP) technique under deep hypothermic circulatory
arrest (DHCA) for aortic arch surgery, the neuropsychological
outcomes of 38 patients with cardiovascular disease were examined
before and after the operation. Thirteen patients undergoing
aortic arch repair with SCP under DHCA (SCP group) were evaluated
with 2 batteries of neuropsychological tests (Benton Visual Retention
Test and Miyakefs Verbal Memory Test) resulting in 4 subscores,
and the results were compared with those of 15 heart surgery
patients who underwent a normal cardiopulmonary bypass (CPB group)
and 10 patients who underwent abdominal aortic aneurysm repair
without CPB (Y group). There were no significant differences
in age, incidence of preoperative cerebrovascular complications,
or mean score on the preoperative neuropsychological tests among
the groups. In the postoperative period, the patients in all
3 groups performed less well than they did preoperatively on
3 of 4 subscores, however, there were no differences among the
3 groups. On 1 of 3 subscores, the postoperative mean score in
the SCP group was significantly lower than the preoperative and
postoperative mean scores in the Y group, whereas there were
no differences between the SCP and CPB groups. In the SCP group,
the patients whose postoperative mean score was lower than the
preoperative score had longer SCP times than the patients without
a lower postoperative mean score. In conclusion, CPB, including
SCP, may be a risk factor for the deterioration of postoperative
neuropsychological function, although each group had deteriorated
test scores in the early postoperative phase and the severity
of the deterioration was not exceedingly high using our SCP methods.
Various factors, such as drugs, anesthesia, surgical technique,
and physical and psychological damage are believed to potentially
have an effect on deteriorated postoperative neuropsychological
function.
@Jpn. J. Cardiovasc. Surg. 33: 244-251 (2004) |
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