Deep hypothermic circulatory arrest with open distal anastomosis performed without cerebral perfusion in ascending aortic and aortic root aneurysm surgery can be performed with acceptable early neurological outcomes, showing significant improvement in verbal memory but a slight decline in general cognitive screening scores one week postoperatively.
Postoperative OVMPT (Oktem Verbal Memory Processes Test) scores showed significant improvement one week after surgery.
MMSE (Mini-Mental State Examination) scores showed a slight but significant postoperative decline one week after surgery.
No significant change was observed in WMS-VR (Wechsler Memory Scale-Visual Reproduction Test) scores postoperatively.
No associations were found between neurocognitive outcomes and operative variables.
The study used deep hypothermic circulatory arrest (DHCA) with open distal anastomosis without cerebral perfusion as the surgical technique.
This research suggests that a specific surgical technique called deep hypothermic circulatory arrest (DHCA) — where the body is cooled to very low temperatures and blood circulation is temporarily stopped to allow surgeons to repair the aorta — can be performed without additional brain protection methods (such as pumping blood directly to the brain) while still achieving acceptable early neurological outcomes. The study followed 36 patients who underwent surgery to repair enlargements (aneurysms) of the ascending aorta or aortic root, testing their cognitive function before and one week after the operation using three standardized memory and cognition tests. The results were mixed but generally reassuring. Patients showed a meaningful improvement in verbal memory scores after surgery, and visual memory scores did not change significantly. However, scores on a general cognitive screening test (the Mini-Mental State Examination) showed a small but statistically significant decline one week after surgery. Importantly, none of the surgical factors measured — such as the length of the procedure or circulatory arrest time — were linked to how patients performed on cognitive tests, suggesting the cognitive changes may not be directly attributable to specific operative decisions. This research matters because surgeons and patients often worry about brain injury following complex heart and aorta surgeries, particularly when blood flow to the brain is temporarily stopped. The findings suggest that for this type of aneurysm repair, relying solely on deep cooling without additional cerebral perfusion may be a viable approach with acceptable short-term brain outcomes. However, the study only assessed patients one week after surgery, so longer-term cognitive effects remain unknown, and the relatively small sample size of 36 patients limits the ability to draw broad conclusions.
Yesilkaya M, Karaagac A, Yuksel G, Can T, Pocan Y, Erturk O, et al.. (2026). Neurological and neurocognitive outcomes of routine deep hypothermic circulatory arrest with open distal anastomosis in ascending aortic and aortic root aneurysm surgery.. Cardiovascular journal of Africa. https://doi.org/10.5830/CVJA-2026-014