Risk Factor Analysis of Delayed Recovery of Consciousness after Aortic Arch Surgery

Objective To determine risk factors of delayed recovery of consciousness after aortic arch surgery under deep hypothermic circulatory arrest(DHCA) and antegrade selective cerebral perfusion(ASCP).MethodsWe retrospectively analyzed clinical data of 113 patients who underwent aortic arch surgery under DHCA+ASCP in the Affiliated Drum Tower Hospital,Medical School of Nanjing University from October 2004 to April 2012.According to whether they regained consciousness within 24 hours after surgery,all the 113 patients were divided into normal group(73 patients including 55 males and 18 females with their average age of 48.1±10.9 years) and delayed recovery group(40 patients including 29 males and 11 females with their average age of 52.2±11.4 years).Risk factors of delayed recovery of consciousness after surgery were evaluated by univariate analysis and multivariate logistic regression analysis.ResultsNine patients(8.0%) died postoperatively,including 5 patients with multi-organ failure,2 patients with heart failure,1 patient with mediastinal infection,and 1 patient with pulmonary hemorrhage.There were 7 deaths(17.5%) in the delayed recovery group and 2 deaths(2.7%) in the normal group,and the in-hospital mortality of the delayed recovery group was significantly higher than that of the normal group(P=0.016).A total of 94 patients(including 65 patients in the normal group and 29 patients in the delayed recovery group) were followed up for 4-95 months.Eight patients(including 5 patients in the normal group and 3 patients in the delayed recovery group) died during follow-up,including 2 patients with stroke,3 patients with heart failure,2 patients with pulmonary hemorrhage and 1 patient with unknown cause.Ten patients were lost during follow-up.Univariate analysis showed that age(P=0.042),hypertension(P=0.017),emergency surgery(P=0.001),cardiopulmonary bypass(CPB) time(P=0.007),aortic cross-clamp time(P=0.021),and blood transfusion(P=0.012)were risk factors of delayed recovery of consciousness after aortic arch surgery.Multivariate logistic regression showed that emergency surgery(P=0.005) and CPB time240 minutes(P=0.000) were independent risk factors of delayed recovery of consciousness after aortic arch surgery.ConclusionDelayed recovery of consciousness after aortic arch surgery is attributed to a combination of many risk factors.Correct patient diagnosis,lesion site and involved scope should be made clear preoperatively in order to choose appropriate surgical strategies.During the surgery,strengthened brain protection,shortened operation time,improved surgical techniques,and perioperative stable circulation maintenance are all important measures to prevent delayed recovery of consciousness after aortic arch surgery.