This prospective study considered patients older than 18 years who underwent total arch replacement combined with stented elephant trunk implantation under cardiopulmonary bypass (CPB) and deep hypothermia circulatory arrest (DHCA) between 20 March 2017 and 14 January 2019 at our hospital. Patients were excluded if they had

a history of stroke in the prior 6 months or any other central nervous system disease, including Parkinson disease, Alzheimer's disease, and encephalitis;

a psychotic disorder or family history of psychotic disorder; or

preoperative cognitive impairment,[15] defined as a Mini-mental State Examination[16] (MMSE) score < 17 if the individual was illiterate, <20 if the individual had only primary school education, or <24 if the individual had at least a middle school education.

Enrolled patients were exited from the study if they died within 24 hours after surgery or suffered stroke after surgery.

This cohort study was approved by the institutional ethics committee of Yan’An Hospital affiliated to Kunming Medical University (2018-069-01). At admission, participants received a written and oral explanation of the study and gave written informed consent to be enrolled in the study.

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