Perioperative and Neurological Complications after Open Thoracic Aortic Surgery in a High-Volume Aortic Surgery Center

Objective: Thoracic aortic surgery is associated with an increased risk of mortality and complications. The present study aimed to evaluate the incidence of 30-day mortality and perioperative major complications after open thoracic aortic surgery in a high-volume aortic center. Materials and Methods: The present study was a retrospective analysis and included patients who underwent open thoracic aortic surgery with cardiopulmonary bypass (CPB) between December 2018 and November 2020. Demographics and perioperative data were analyzed. The incidence of 30-day mortality and risk factors of perioperative and neurological complications were determined. Results: One hundred ninety-five patients were included in the present study. Most were male, at 67.2%, with a mean age of 59.3±14.5 years. The incidence of 30-day mortality was 4.6%, with a 95% confidence interval (CI) 2.5 to 8.5. The major complication characterized by the Clavien-Dindo classification was 40.5%. The multivariable analysis identified aortic arch surgery (adjusted odds ratio (aOR) 2.86, 95% CI 1.11 to 7.33, p=0.029), maximum vasoactive-inotropic (VISmax) score greater than 10 (aOR 2.58, 95% CI 1.01 to 6.64, p=0.049), and VISmax score greater than 20 (aOR 5.54, 95% CI 1.67 to 18.34, p=0.005) as significant risk factors for postoperative major complications. In addition, aortic arch surgery, preoperative neurological complications (aOR 4.01, 95% CI 1.47 to 10.95, p=0.007), cerebral desaturation of greater than 20% reduction of regional cerebral oxygen saturation rScO₂ during CPB (aOR 4.60, 95% CI 1.49 to 14.15, p=0.008), and red blood cell transfusions of more than one blood volume (aOR 4.19, 95% CI 1.01 to 17.36, p=0.048) were identified as risk factors for postoperative stroke. Conclusion: The present study demonstrated a 30-day mortality rate of 4.6% after thoracic aortic surgery. Operations of the aortic arch and VISmax score of greater than 10 are associated with an increased risk of major postoperative complications. Reduction of rScO₂ during CPB is strongly associated with postoperative stroke.