Risk factors of nervous system complications after aortic arch surgery under shallow-moderate hypothermia circulatiory arrest and their relationship with intraoperative lowest bladder temperature

Deng Yiquan; Cheng Xiangjun; Li Min; Li Lunmin

doi:10.13498/j.cnki.chin.j.ecc.2024.05.04

Abstract：Objective To investigate the risk factors of nervous system complications after aortic arch surgery under shallow-moderate hypothermia circulatory arrest and their relationship with intraoperative lowest bladder temperature to provide more reference for temperature control and prognosis improvement during intraoperative circulation arrest. Methods A total of 123 patients who underwent aortic arch surgery under shallow-moderate hypothermia circulatory arrest from January 2016 to January 2023 in our hospital were retrospectively selected. Based on the occurrence of postoperative neurological complications,the patients were divided into two groups:complication group (35 cases) and non-complication group (88 cases). Univariate and logistic regression models were used to identify independent risk factors for neurological complications,and multiple linear regression models were used to evaluate the relationship between intraoperative lowest bladder temperature and the risk of neurological complications. Results Univariate analysis showed that preoperative cerebral perfusion,intraoperative lowest bladder temperature,operative time,cardiopulmonary bypass time and ascending aorta occlusion time might be related to the occurrence of neurological complications in patients undergoing aortic arch surgery (P<0.05). Multivariate analysis using logistic regression model showed that preoperative poor cerebral perfusion and intraoperative lowest bladder temperature were independent risk factors for neurological complications in patients undergoing aortic arch surgery (OR=1.26,1.85,95％CI:1.12～4.48,1.37～6.83,P<0.05). Multiple linear regression model analysis showed that intraoperative lowest bladder temperature was independently associated with the risk of postoperative neurological complications (OR=0.54,95％CI:0.30～0.91,P=0.02). Intraoperative lowest bladder temperature of 30～34℃ was the independent protective factor for neurological complications (OR=0.07,95％CI:0.01～0.92,P=0.04). Conclusion The incidence of neurological complications in patients undergoing shallow-moderate hypothermia circulatory arrest aortic arch surgery was related to preoperative cerebral perfusion and intraoperative lowest bladder temperature. Intraoperative hypothermia of the bladder may be helpful to reduce the risk of neurological complications.