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Eur J Cardiothorac Surg 2005;28:97-101
© 2005 Elsevier Science NL
a Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan
b School Education Center, University of Tsukuba, Tokyo, Japan
c Department of Public Health, University of Tokyo, Tokyo, Japan
Received 29 May 2004; received in revised form 7 October 2004; accepted 13 December 2004.
* Corresponding author. Address: Department of Cardiovascular Surgery, Mitsui Memorial Hospital, 1 Kandaizumicho Chiyodaku, Tokyo 101-8643, Japan. Tel.: +81 3 3862 9111; fax: +81 3 5687 9765. (Email: tmiyairi-tky{at}umin.ac.jp).
Objective: Retrograde cerebral perfusion (RCP) is used as an adjunctive method to hypothermic circulatory arrest to enhance cerebral protection in patients undergoing thoracic aortic surgery. It remains unclear whether RCP provides improved neurological and neuropsychological outcome. Methods: Forty-six patients undergoing thoracic aortic surgery using RCP, and 28 undergoing coronary artery bypass grafting (CABG; n=28) with CPB, were enrolled in the study. Patients receiving RCP were subdivided into two groups, those with less than 60min of RCP (S-RCP; n=27) and with 60min or more (L-RCP; n=19). The patients' neurocognitive state was assessed by the revised Wechsler Adult Intelligence Scale a few days before operation, at 2–3 weeks and 4–6 months after operation. Results: There were no stroke, seizure, and hospital mortality in either group. Significant decline between baseline and early scores were seen in three subtests (digit span, arithmetic, and picture completion) for S-RCP and four (digit span, arithmetic, picture completion, and picture arrangement) for L-RCP. Significant decline between baseline and late scores were seen in one subtest (arithmetic) for S-RCP, four (digit span, arithmetic, picture completion, and picture arrangement) for L-RCP, and one (object assembly) for CABG. The mean change of scores for one late test (digit symbol) was significantly lower in S-RCP than in CABG. The mean change of scores for three early tests (digit span, vocabulary, and picture arrangement) and four late tests (information, digit span, picture completion, and picture arrangement) were significantly lower in L-RCP than in CABG. Stepwise logistic regression analysis disclosed that, after considering the other variables, significant difference in test score changes were observed between CABG and L-RCP for two early tests (picture completion and digit symbol) as well as for three late tests (digit span, similarities, and picture completion). None of test score changes showed significant difference between CABG and S-RCP. Conclusions: The neurocognitive outcome in patients undergoing RCP less than 60min were comparable with patients undergoing CABG without circulatory arrest. Prolonged RCP of 60min or more in patients undergoing surgery of the thoracic aorta was associated with postoperative neurocognitive impairment.
Key Words: Neurocognitive function • Retrograde cerebral perfusion • Hypothermic circulatory arrest • Thoracic aortic surgery • Brain protection
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