Key result
Transient neurological dysfunction after thoracic aorta surgery was associated with impaired quality of life and more strokes (14.6% vs 4.8%), despite similar in-hospital mortality (12.0% vs 11.4%).
Why the study?
Does transient neurological dysfunction affect short- and long-term outcomes and quality of life in patients undergoing surgery of the ascending aorta and proximal arch?
Cohort (n=907)
No
Does transient neurological dysfunction affect short- and long-term outcomes and quality of life in patients undergoing surgery of the ascending aorta and proximal arch?
Absolute Event Rate: 12% vs 11.4%
p-value: p=ns
Transient neurological dysfunction after thoracic aortic surgery is a significant predictor of prolonged hospitalization, permanent stroke, and impaired long-term quality of life.
May warrant enhanced stroke surveillance after thoracic aorta surgery; leaves open whether targeted interventions improve long-term outcomes.
BACKGROUND: Transient neurological dysfunction (TND) consists of postoperative confusion, delirium and agitation. It is underestimated after surgery on the thoracic aorta and its influence on long-term quality of life (QoL) has not yet been studied. This study aimed to assess the influence of TND on short- and long-term outcome following surgery of the ascending aorta and proximal arch. METHODS: Nine hundred and seven patients undergoing surgery of the ascending aorta and the proximal aortic arch at our institution were included. Two hundred and ninety patients (31.9%) underwent surgery because of acute aortic dissection type A (AADA) and 617 patients because of aortic aneurysm. In 547 patients (60.3%) the distal anastomosis was performed using deep hypothermic circulatory arrest (DHCA). TND was defined as a Glasgow coma scale (GCS) value <13. All surviving patients had a clinical follow up and QoL was assessed with an SF-36 questionnaire. RESULTS: Overall in-hospital mortality was 8.3%. TND occurred in 89 patients (9.8%). As compared to patients without TND, those who suffered from TND were older (66.4 vs 59.9 years, p<0.01) underwent more frequently emergent procedures (53% vs 32%, p<0.05) and surgery under DHCA (84.3% vs 57.7%, p<0.05). However, duration of DHCA and extent of surgery did not influence the incidence of TND. In-hospital mortality in the group of patients with TND compared to the group without TND was similar (12.0% vs 11.4%; p=ns). Patients with TND suffered more frequently from coronary artery disease (28% vs 20.8%, p=ns) and were more frequently admitted in a compromised haemodynamic condition (23.6% vs 9.9%, p<0.05). Postoperative course revealed more pulmonary complications such as prolonged mechanical ventilation. Additional to their transient neurological dysfunction, significantly more patients had strokes with permanent neurological loss of function (14.6% vs 4.8%, p<0.05) compared to the patients without TND. ICU and hospital stay were significantly prolonged in TND patients (18+/-13 days vs 12+/-7 days, p<0.05). Over a mean follow-up interval of 27+/-14 months, patients with TND showed a significantly impaired QoL. CONCLUSION: The neurological outcome following surgery of the ascending aorta and proximal aortic arch is of paramount importance. The impact of TND on short- and long-term outcome is underestimated and negatively affects the short- and long-term outcome.
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Krähenbühl et al. (2008) conducted a cohort in Surgery of the ascending aorta and proximal arch (n=907). Transient neurological dysfunction vs. No transient neurological dysfunction was evaluated on In-hospital mortality (p=ns). Transient neurological dysfunction after thoracic aorta surgery was associated with impaired quality of life and more strokes (14.6% vs 4.8%), despite similar in-hospital mortality (12.0% vs 11.4%).
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