Leukoaraiosis and hippocampal atrophy predict neurologic outcome in patients who undergo total aortic arch replacement.

Background: This retrospective study determined whether leukoaraiosis and hippocampal atrophy seen in preoperative magnetic resonance imaging (MRI) predict neurologic outcome after total aortic arch replacement.

Methods: From August 2001 to November 2007, 131 consecutive patients (22% women) who underwent elective total arch replacement with selective cerebral perfusion were enrolled. Mean patient age was 71 +/- 17 years (range, 27 to 88 years). On preoperative MRI, mean leukoaraiosis score and hippocampal atrophy score, rated according to the Scheltens scale, were 11.0 +/- 9.2 and 1.5 +/- 1.9, respectively. Forty-three patients (32.8%) had carotid or basilica arterial stenosis, 18 (12.6%) had a stroke, and 6 (4.2%) had a transient ischemic attack.

Results: One hospital death (0.8%) occurred. Adverse perioperative neurologic events included intraoperative stroke in 8 (6.1%), postoperative stroke in 2 (1.5%), and temporary neurologic dysfunction (TND) in 11 (8.4%). On multivariate logistic regression, significant predictors of postoperative intraoperative stroke were leukoaraiosis (odds ratio [OR], 1.1, p = 0.02) and aortic arch atheroma (OR, 2.4; p = 0.001). TND was significantly associated with leukoaraiosis (OR, 1.1, p = 0.03) and hippocampal atrophy (OR, 1.6, p = 0.01). The best cutoff value for predicting intraoperative stroke was a leukoaraiosis score exceeding 16 (sensitivity, 70%; specificity, 70%); that for predicting TND was a leukoaraiosis score exceeding 18 (sensitivity, 82%; specificity, 77%) and a hippocampal atrophy score exceeding 2 (sensitivity, 82%; specificity, 76%).

Conclusions: Leukoaraiosis and hippocampal atrophy are significant independent factors for adverse neurologic outcome after total arch replacement.