Analysis of Neurological Complications After Reconstructive Procedures on the Aortic Arch Using Unilateral and Bilateral Cerebral Perfusion

Highlights Postoperative incidence of acute cerebrovascular events following reconstructive interventions on the aortic arch ranges from 5.8% to 10.6%. Therefore, investigating the causes and consequences of these neurological complications to develop effective preventive strategies is of paramount importance in cardiac surgery. Aim . To compare the frequency of neurological complications and identify their predictors in patients receiving unilateral and bilateral cerebral perfusion during aortic arch surgery Methods . Between September 2023 and January 2025, 60 patients admitted to the E. Meshalkin National Medical Research Center with subacute and chronic diseases of the aortic arch were included in this study. Patients were randomly assigned to two groups based on the type of perfusion during circulatory arrest. The first group consisted of patients with unilateral cerebral perfusion, while the second group consisted of patients with bilateral cerebral perfusion. During the hospital stay, a comparative analysis of baseline clinical, perioperative, and postoperative data were evaluated. The frequency and causes of postoperative complications within 30 days of surgery were determined, as well as their relationship with neurological complications. Results. Stroke were present in 6,67% (n = 2) in the first group and 10% (n = 3) in the second group (p = 1,0), while transient neurological disorders were observed in 16,67% (n = 5) in the first group and 13,33% (n = 4) in the second group, respectively (p = 1,0). Predisposing factors for stroke included hemodynamic disturbances of normal blood flow in right carotid and/or brachiocephalic arteries and carotid-subclavian bypass. Risk factor for transient neurological disorders were total aortic arch replacements. In the postoperative period, transient neurological symptoms increased the duration of stay in the intensive care unit, while stroke patients additionally faced the elevated risks of developing hospital pneumonia, multiorgan failure, and prolonged mechanical ventilation. Conclusion. Both options of antegrade brain perfusion demonstrate comparable results regarding the number of neurological complications during reconstructive procedures on the aortic arch. The data obtained from logistic regression indicate that any factors contributing to cerebral ischemia increase the risk of acute cerebrovascular events and negatively impact the patient's prognosis.