16. PREDICTORS OF ADVERSE OUTCOME AND TRANSIENT NEUROLOGIC DYSFUNCTION AFTER ASCENDING AORTA/ARCH REPLACEMENT
Marek P. Ehrlich, M. Arisan Ergin, Jock N. McCullough, Jan D. Galla, Khanh H. Nguyen, Steven L. Lansman, Carol A. Bodian, Anil Apaydin, Randall B. Griepp
The Mount Sinai Medical Center
New York, New York, USA
BACKGROUND
Predictors of adverse outcome after replacement of the ascending aorta with an open distal anastomosis were analyzed in all 443 patients (300 male, median age 63) undergoing operation between 1986 and 1998. The ascending aorta alone was replaced in 190 (42.9%); 253 (57.1%) also had proximal arch replacement. Median hypothermic circulatory arrest (HCA) time was 25 minutes (range 12-68).
METHODS AND RESULTS
Either death or permanent neurologic dysfunction were considered adverse outcome (AO). AO occurred in 11.5 percent (51/443) of patients overall: in 7.4% of elective (20/269) or urgent (4/54) operations, but in 17 percent (19/113) of emergencies. Transient neurologic dysfunction (TND) occurred in 22 percent (86/392). Survival of discharged patients was 93% at one and 83% at five years.
Multivariate analysis revealed that significant (P < 0.05) independent preoperative predictors of AO were age > 60 (odds ratio [OR] 2.2), hemodynamic instability (OR 2.7), and dissection (OR 1.9). For the 435 operative survivors, procedural variables predictive of AO were contained rupture (OR 2.8) and HCA time (OR 1.03/min). Significant predictors of TND were age (OR 1.06/yr), HCA time (OR 1.04/min), coronary artery disease (OR 2.2), hemodynamic instability (OR 3.4), and acute operation (OR 2.2).
CONCLUSION
Early elective operation and shorter HCA time during ascending aorta/arch surgery will reduce both AO and TND.
