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Ann Thorac Surg 2000;69:1763
© 2000 The Society of Thoracic Surgeons

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Discussion

Discussion

DR ALVAN W. ATKINSON (Raleigh, NC): I just wondered, did you use circulatory arrest without retrograde cerebral perfusion or did you use it in some patients, and if so, did you notice any change in your statistics?

DR MCCULLOUGH: Actually our group is using retrograde cerebral perfusion in a much more limited fashion over the last couple of years. We tend to use retrograde cerebral perfusion more as a "washout" technique, a brief interval at the end of the procedure to wash out gross macroscopic debris from the arch. So, the number of patients in this series that had any significant retrograde cerebral perfusion was small and was actually correlated with a worse outcome, but we did not make too much of that in this paper because our group used retrograde cerebral perfusion in patients who we thought were at higher risk. So, yes, it was used in a small portion of the patients and it was associated with a worse outcome.

DR WILLIAM A. BAUMGARTNER (Baltimore, MD): I would like to congratulate Dr Ehrlich and his group. As we all are aware, their institution is one of the leading ones in this field of aortic surgery. I think your work has helped us to understand a lot about the risks and methods of these complicated procedures.

I have a couple of questions regarding transient neurologic dysfunction. As you know, we have been very interested in this aspect of it because I think it is the one area that we, perhaps, might be able to control some day. What was the incidence of transient neurologic dysfunction? I know you have done work on cognitive evaluation of patients in the past, and I wonder if any of these patients had pre and postoperative testing performed.

DR McCULLOUGH: Transient neurological dysfunction defined in this series of patients is the surgeon’s observation of postoperative delirium, prolonged confusion, any nonfocal and ultimately grossly resolved neurological dysfunction during their hospitalization. This group did not have any systematic application of neuropsychiatric or neuropsychological testing as in our previous paper, but our previous paper did show in patients that underwent circulatory arrest, if they performed poorly on their early neuropsych testing, that was a strong predictor of a poor performance later.

So, transient neurological dysfunction would probably correlate with poor performance on early neuropsych testing, and that would be associated with poorer late neuropsych performance, particularly in the domains of fine motor function and memory.

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