Background and Objectives:
Cerebral malperfusion is a serious complication in the anesthetic management of patients with acute
type A dissection of aorta (DA). Especially, cerebral perfusion can be restricted if the dissected area
involves the aortic arch and the cervical branches.
Although previous studies have reported that operation time and an intraoperative depression of
regional cerebral oxygen saturation (rSO2) can be predictive factors for detecting cerebral
malperfusion in patients with DA, the sensitivity and specificity are unclear in subjects with DA
involving the aortic arch. In addition, independent risk factors other than rSO2 for cerebral
malperfusion in patients with DA involving the aortic arch are yet to be investigated
We conducted this study to investigate the factors which are correlated with postoperative cerebral
infarction (CI) in patients with DA involving the aortic arch.
Materials and methods:
We included 85 patients who underwent urgent aortic surgery involving arch dissection from
December 2010 to October 2016. The patients were divided into two groups on the basis of the
occurrence of postoperative CI: a CI group and nonCI
group.
Data of operation time, cardiopulmonary bypass time, aortic clamping time, selective cerebral
perfusion time, circulatory arrest time, amount of bleeding, amount of transfusion, and rSO2 values
were collected from the anesthesia record. The time duration of rSO2 depression of less than 50%
were accumulated for each patient. Statistical analysis was performed using the nonpaired
ttest,
logistic regression, and receiver operating characteristic curve (ROC) analysis.
A p value of less than 0.05 was considered as significant.
Results:
There were 28 and 57 patients allocated to the CI group and nonCI
group, respectively.
Through descriptive analysis and logistic regression, independent risk factors for CI were as
follows: operation time (OR=1.01, 95%CI 1.001.02),
and time duration of rSO2 below 50%(
OR=1.01, 95%CI 1.001.02).
ROC analysis revealed that an rSO2 depression below 50% of longer than 39 minutes was a
significant independent predictor of postoperative CI (Sensitivity: 75% Specificity: 67%, P=0.0003).
Conclusion:
Our results indicate that prolonged depression in rSO2 and operation time are useful predictors for
postoperative CI in patients with DA involving the aortic arch. Early intervention for cerebral
perfusion is needed in patients who experience a prolonged rSO2 depression.

Regional cerebral oxygen saturation is a useful predictive factor of postoperative cerebral infarction in acute dissection of aorta involving the aortic arch