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Original Articles: Adult Cardiac

Leukoaraiosis and Hippocampal Atrophy Predict Neurologic Outcome in Patients Who Undergo Total Aortic Arch Replacement

^a Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
^b Division of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
^c Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

Accepted for publication April 8, 2009.

^_* Address correspondence to Dr Morimoto, Division of Cardiovascular Surgery, Kobe University, 7-5-1 Kusunoki-cho, Chuuo-ku, Kobe, Hyogo, 650–0017, Japan (Email: naotofrcs{at}gmail.com).

Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: This retrospective study determined whether leukoaraiosis and hippocampal atrophy seen in preoperative magnetic resonance imaging (MRI) predict neurologic outcome after total aortic arch replacement.

Methods: From August 2001 to November 2007, 131 consecutive patients (22% women) who underwent elective total arch replacement with selective cerebral perfusion were enrolled. Mean patient age was 71 ± 17 years (range, 27 to 88 years). On preoperative MRI, mean leukoaraiosis score and hippocampal atrophy score, rated according to the Scheltens scale, were 11.0 ± 9.2 and 1.5 ± 1.9, respectively. Forty-three patients (32.8%) had carotid or basilica arterial stenosis, 18 (12.6%) had a stroke, and 6 (4.2%) had a transient ischemic attack.

Results: One hospital death (0.8%) occurred. Adverse perioperative neurologic events included intraoperative stroke in 8 (6.1%), postoperative stroke in 2 (1.5%), and temporary neurologic dysfunction (TND) in 11 (8.4%). On multivariate logistic regression, significant predictors of postoperative intraoperative stroke were leukoaraiosis (odds ratio [OR], 1.1, p = 0.02) and aortic arch atheroma (OR, 2.4; p = 0.001). TND was significantly associated with leukoaraiosis (OR, 1.1, p = 0.03) and hippocampal atrophy (OR, 1.6, p = 0.01). The best cutoff value for predicting intraoperative stroke was a leukoaraiosis score exceeding 16 (sensitivity, 70%; specificity, 70%); that for predicting TND was a leukoaraiosis score exceeding 18 (sensitivity, 82%; specificity, 77%) and a hippocampal atrophy score exceeding 2 (sensitivity, 82%; specificity, 76%).

Conclusions: Leukoaraiosis and hippocampal atrophy are significant independent factors for adverse neurologic outcome after total arch replacement.

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Mark M. Stecker
Ann. Thorac. Surg. 2009 88: 481. [Extract] [Full Text] [PDF]

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