Risk Factors for Early Postoperative Cognitive Dysfunction in Aortic Arch Replacement.

Abstract

Background: Postoperative cognitive dysfunction (POCD) is a common complication following aortic arch replacement. This study aimed to identify risk factors for early POCD in patients undergoing aortic arch replacement and determine the effect of POCD on long-term survival.

Methods: In this prospective cohort study, 103 patients who underwent aortic arch replacement for complex aortic arch diseases were enrolled. Cognitive function was assessed preoperatively and on postoperative days 5 to 7 using the Montreal Cognitive Assessment. POCD was defined as a ≥20% decline in total score compared with baseline.

Results: The incidence of POCD was 15.5%. Compared with the non-POCD group, patients with POCD were significantly older (62 ± 13 vs. 52 ± 13, p = 0.008), had a higher proportion of females (68.8 vs. 37.9%, p = 0.044), and experienced greater intraoperative blood loss (751 ± 165 vs. 667 ± 122 mL; p = 0.018). Postoperative adverse events were similar between the two groups. Significant declines were observed in the domains of visuospatial/executive function (p = 0.003), attention/concentration/working memory (p < 0.001), and orientation (p = 0.002). Multivariable logistic regression analysis identified age, female sex, and antegrade cerebral perfusion (ACP) time as independent risk factors for POCD. Midterm survival was similar between POCD and non-POCD groups (1-year survival: 100 vs. 95.2%; p = 0.437).

Conclusion: POCD remains a common complication after aortic arch replacement. Advanced age, female sex, and prolonged ACP time are independent predictors of POCD. POCD was not associated with worse midterm survival. These findings may help preoperative risk stratification and optimization of intraoperative management.