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 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 (Delta rSO(2)min) in each time period were risk factors for postoperative PND. The ROC curve measurement showed that the optimal cut-off value of Delta rSO(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 Delta rSO(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 Delta rSO(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 Delta rSO(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.