Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova · 2021
[Risk factors for neurological complications in the late period after operations on the ascending aortic arch].
СтатьяНазвание и аннотация: Перевод в очереди
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Medvedeva L A, Eremenko A A, Oystrakh A S, Drakina O V, Charchyan E R, Akselrod B A
Аннотация
OBJECTIVE: To assess the risk factors for unfavorable neurological outcomes in the long-term follow-up periods (after 5 and 10 years) in patients undergoing planned operations on the ascending and arch of the aorta.
MATERIAL AND METHODS: The prospective study included 100 patients who were operated on at the FSBSI Petrovsky Russian Research Center of Surgery and were observed over a long period of time (up to 10 years). Patients of group I (n=50) underwent surgery on the aortic arch with antegrade cerebral perfusion and hypothermic circulatory arrest (26 °C). Patients of group II (n=50) underwent prosthetics of the ascending aorta with extracorporeal circulation with moderate hypothermia (32 °C). All patients performed cognitive tests before and after surgery, as well as 5 and 10 years after reconstruction. Possible risk factors were analyzed with respect to 3 expected negative consequences: postoperative delirium, neurocognitive dysfunction and long-term neurological disorders after 5 and 10 years of follow-up.
RESULTS: Long-term cognitive impairments were statistically significantly associated with the following predictors: age, baseline presence of mild cognitive impairment, episodes of intraoperative microembolism, episodes of decreased cerebral perfusion, and delirium. The presence of short-term cognitive impairments in the immediate postoperative period was a significant risk factor for detecting impairments 5 and 10 years after surgery.
CONCLUSION: For the possibility of preventing long-term unfavorable outcomes of the intellectual sphere, the main attention should be directed to the dynamics of the patient's neurological state in the immediate postoperative period.
MATERIAL AND METHODS: The prospective study included 100 patients who were operated on at the FSBSI Petrovsky Russian Research Center of Surgery and were observed over a long period of time (up to 10 years). Patients of group I (n=50) underwent surgery on the aortic arch with antegrade cerebral perfusion and hypothermic circulatory arrest (26 °C). Patients of group II (n=50) underwent prosthetics of the ascending aorta with extracorporeal circulation with moderate hypothermia (32 °C). All patients performed cognitive tests before and after surgery, as well as 5 and 10 years after reconstruction. Possible risk factors were analyzed with respect to 3 expected negative consequences: postoperative delirium, neurocognitive dysfunction and long-term neurological disorders after 5 and 10 years of follow-up.
RESULTS: Long-term cognitive impairments were statistically significantly associated with the following predictors: age, baseline presence of mild cognitive impairment, episodes of intraoperative microembolism, episodes of decreased cerebral perfusion, and delirium. The presence of short-term cognitive impairments in the immediate postoperative period was a significant risk factor for detecting impairments 5 and 10 years after surgery.
CONCLUSION: For the possibility of preventing long-term unfavorable outcomes of the intellectual sphere, the main attention should be directed to the dynamics of the patient's neurological state in the immediate postoperative period.