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Old April 12th, 2013 #3628
Donald E. Pauly
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Join Date: Dec 2003
Location: Las Vegas
Posts: 4,130
Angry Japanese Paper on Aorta Surgery Brain Damage

I was tipped off about this 16-year-old paper which is apparently in Japanese. The abstract has been translated. It appears that the Japs do not use the term pumphead to describe the problem. Note that 13% of the patients operated on had irreversible brain damage. NONE of these aneurysms had ruptured. When that happens, clots form BEFORE surgery and are carried to the brain.

Steele's aneurysm ruptured an HOUR before surgery. His problems are expected to be a hundred times worse than when the aneurysm is fixed BEFORE rupture. As far as I can find, Steele is the only one to survive for an hour before surgery. He is a walking medical curiosity. It is not particularly surprising that he is crazy but it is surprising that he had as many brains left as he did.

Quote:
Nihon Kyobu Geka Gakkai Zasshi. 1997 Oct;45(10):1678-84.
[Brain damage after surgery for thoracic aortic aneurysm].
[Article in Japanese]
Inada H, Tabuchi A, Morita I, Masaki H, Murakami T, Fujiwara T.
Source
Department of Surgery, Kawasaki Medical School, Okayama, Japan.
Abstract

We analyzed cases with brain damage after surgery for thoracic aortic aneurysm in our institution and investigated the causes, risk-factors and preventive measures for this disastrous postoperative complication. Irreversible brain damage was a complication in 25 out of 184 operative cases (13.6%) over a 21-year period.

The cause of brain damage was determined to be embolism by manipulation of the aorta in six cases, clamping of the left subclavian artery in four cases, technical problems of separate cerebral perfusion (SCP) in four cases, severe shock in three cases, embolism unrelated to operative maneuver in three cases, stenosis of a branch of the arch with aortic dissection in two cases, and air embolism, circulatory arrest with insufficient hypothermia and hypoperfusion of a temporary bypass to the left carotid artery in one case each.

The neurological symptom improved in eight cases and was unchanged in 17 cases. Eighteen cases died in the hospital. In the univariate analysis, age (p = 0.048), a portion of the aneurysm (p = 0.035), preoperative brain complication (p = 0.003), emergency operation (p = 0.033) and clamping of the arch (p = 0.001) were found to be prominent risk factors for brain damage. In the multivariate analysis, clamping of the arch (p = 0.0310), SCP (p = 0.0327) and emergency operation (p = 0.0223) were prominent. To prevent postoperative brain damage, the arch should not be clamped, appropriate operative techniques to avoid bleeding and to shorten SCP time should be employed, and proper and prompt management of the emergency operation and caution in clamping the left subclavian artery are considered to be necessary.

PMID: 9394576 [PubMed - indexed for MEDLINE]

Last edited by Donald E. Pauly; April 13th, 2013 at 09:30 PM. Reason: typo