Risk Factors for Hypoxemia After Surgery for Acute Type A Aortic Dissection

Nakajima, Takayuki; Kawazoe, Kohei; Izumoto, Hiroshi; Kataoka, Tsuyoshi; Niinuma, Hiroyuki; Shirahashi, Nobuo

doi:10.1007/s00595-006-3226-5

Cited by 37 publications

(50 citation statements)

References 16 publications

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“…In this series of 333 patients undergoing surgical repair of acute type A aortic dissection by means of DHCA, spanning a 5-year time period, 136 patients were diagnosed as presurgical mild ARDS, with an incidence of 40.8%. The incidence of presurgical mild ARDS in this series was similar to other series which reported the incidence of 30-45%, [1][2][3][4][5] and this study showed that patients in the mild-ARDS group, compared with the no-ARDS group, had significantly higher plasma levels of inflammatory marker, C-reactive protein, which was consistent with the findings of previous studies. [17][18][19] So, this study again suggested that systemic inflammation played an important role in the occurrence and development of mild ARDS.…”

Section: Discussionsupporting

confidence: 82%

“…According to published data, [1][2][3][4][5] acute lung injury (or mild ARDS) is one of most common presurgical compli-cations caused by systemic inflammatory response resulted from aortic injury due to acute type A aortic dissection. In this series of 333 patients undergoing surgical repair of acute type A aortic dissection by means of DHCA, spanning a 5-year time period, 136 patients were diagnosed as presurgical mild ARDS, with an incidence of 40.8%.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Although it is recognized that activation of the inflammatory system caused by aortic injury due to acute aortic dissection may play a crucial role in the occurrence and development of acute lung injury, 1,5,6) the specific mechanism is still unclear. Acute lung injury or even severe ARDS is considered to be systemic complications of acute aortic dissection rather than a simple pulmonary disease.…”

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confidence: 99%

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Impact of Presurgical Mild Acute Respiratory Distress Syndrome on Surgical Mortality After Surgical Repair of Acute Type A Aortic Dissection

Lai²,

Sun

et al. 2017

Int. Heart J.

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SummaryTo evaluate the impact of presurgical mild acute respiratory distress syndrome (ARDS) on surgical mortality in patients undergoing surgical repair of acute type A aortic dissection by means of deep hypothermic circulatory arrest (DHCA) in a single-center, retrospective study.From January 2011 to December 2015, 333 eligible patients were divided into either a mild-ARDS group (n = 136) or a no-ARDS group (n = 197). The definition of mild ARDS referred to the recent revision of ARDS definition (Berlin criteria). The surgical mortality and major postoperative morbidity were investigated and analyzed.A total of 136 patients developed presurgical mild ARDS, with an incidence of 40.8%. No significant difference emerged between the 2 groups in major postoperative morbidity except for pulmonary complications. Multivariate logistic regression displayed that the risk of postoperative pulmonary complications in patients with presurgical mild ARDS was 4.25 times that in patients without presurgical ARDS (OR = 4.25, 95% CI 2.05-7.72). Twenty-four patients died after surgery, with significantly higher surgical mortality in the mild-ARDS group compared with the no-ARDS group (12.5% versus 3.6%, P = 0.002). Kaplan-Meier curves showed a poor surgical survival in the mild-ARDS group (χ 2 =12.958, Log-Rank P < 0.001). And Cox regression revealed the hazard ratio for surgical mortality in the mild-ARDS group compared with the no-ARDS group was 2.52 (95%CI 1.41-5.32, P = 0.016).Presurgical mild ARDS increased postoperative respiratory morbidity, and then increased surgical mortality after surgical repair of acute type A aortic dissection by means of DHCA (Int Heart J 2017; 58: 739-745) Key words: Mild acute respiratory distress syndrome, Acute type A aortic dissection, Deep hypothermic circulatory arrest, Surgical mortality, Morbidity A cute lung injury, which was used to describe mild acute respiratory distress syndrome (ARDS) previously, is one of most common presurgical complications following acute aortic dissection, with a prevalence of 30-45%. [1][2][3][4] Although it is recognized that activation of the inflammatory system caused by aortic injury due to acute aortic dissection may play a crucial role in the occurrence and development of acute lung injury, 1,5,6) the specific mechanism is still unclear. Acute lung injury or even severe ARDS is considered to be systemic complications of acute aortic dissection rather than a simple pulmonary disease. 7)An overwhelming majority of previous studies focused on evaluating risk factors for presurgical mild ARDS following acute aortic dissection, identifying the predictors for hypoxemia following surgical repair of acute type A aortic dissection by means of deep hypothermic circulatory arrest (DHCA), and exploring the pathogenesis of postoperative hypoxemia. However, few reports focused on evaluating the impacts of presurgical mild ARDS on surgical mortality and major postoperative morbidity in patients undergoing surgical repair of acute type A aortic dissection by means of DHC...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of Presurgical Mild Acute Respiratory Distress Syndrome on Surgical Mortality After Surgical Repair of Acute Type A Aortic Dissection

Lai²,

Sun

et al. 2017

Int. Heart J.

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“…Although open heart surgery for treating Stanford A aortic dissection has been a universal option, the patients are still threatened by the lethal perioperative complications such as hemorrhage, hypoxemia, renal dysfunction, cerebral dysfunction and etc. Postoperative hypoxemia is defined as an oxygen fraction (PaO 2 /FiO 2 ) ≤200 mmHg under mechanical ventilation in the first 24 hour after surgery [1]. As a matter of fact, postoperative hypoxemia resembles ARDS (acute respiratory distress syndrome) when oxygen fraction is below 200 mmHg.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery

Wang

Xue

Zhu

2013

J Cardiothorac Surg

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BackgroundThe purpose of this study is to identify the risk factors for postoperative hypoxemia in patients with Stanford A aortic dissection surgery and their relation to clinical outcomes.MethodsClinical records of 186 patients with postoperative hypoxemia in Stanford A aortic dissection were analyzed retrospectively. The patients were divided into two groups by postoperative oxygen fraction (PaO2/FiO2):hypoxemia group (N=92) and non-hypoxemia group (N=94).ResultsWe found that the incidence of postoperative hypoxemia was 49.5%. Statistical analysis by t-test and χ2 indicated that acute onset of the aortic dissection (p=0.000), preoperative oxygen fraction (PaO2/FiO2) ≤200 mmHg(p=0.000), body mass index (p=0.008), circulatory arrest (CA) time (p=0.000) and transfusion more than 3000 ml(p=0.000) were significantly associated with postoperative hypoxemia. Multiple logistic regression analysis showed that preoperative hypoxemia, CA time and transfusion more than 3000 ml were independently associated with postoperative hypoxemia in Stanford A aortic dissection.ConclusionOur results suggest that postoperative hypoxemia is a common complication in patients treated by Stanford A aortic dissection surgery. Preoperative oxygen fraction lower than 200 mmHg, longer CA time and transfusion more than 3000 ml are predictors of postoperative hypoxemia in Stanford A aortic dissection.

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“…1,2 If surgical stress could be minimized by reducing the duration of brain ischemic stress, CPB, and operative procedures, the surgical outcome for AAD could be improved. We describe our newly modifi ed procedure named "less invasive quick replacement" (LIQR) characterized by moderate hypothermic arrest and aggressive rapid rewarming to prevent the complications associated with DHA, extended cerebral protection, CPB, and operative times.…”

Section: Introductionmentioning

confidence: 99%

Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection

et al. 2009

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We describe a newly modified technique, which we term "less invasive quick replacement" (LIQR) for type A acute aortic dissection (AAD). After cooling to a rectal temperature of 28 degrees C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass (CPB) circuit was warmed up to 40 degrees C during open distal anastomosis. As soon as the distal anastomosis was completed, rapid rewarming was initiated by perfusing blood at 40 degrees C. The average CPB and total operative times were 71.8 +/- 9.6 and 130.6 +/- 7.7 min, respectively. The shortest operative time was 101 min from skin incision to skin closure. All patients were weaned off the ventilator within 12 h of surgery. The postoperative hospital stay was 9.3 +/- 1.2 days. There was no incidence of cerebral damage or hospital mortality. Our initial results showed LIQR to be safe and effective.

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Risk Factors for Hypoxemia After Surgery for Acute Type A Aortic Dissection

Abstract: Initiating early treatment for hypoxemia and reducing the volume of blood transfused intraoperatively may improve the postoperative clinical course of obese patients with preoperative hypoxemia.

Cited by 37 publications

References 16 publications

Impact of Presurgical Mild Acute Respiratory Distress Syndrome on Surgical Mortality After Surgical Repair of Acute Type A Aortic Dissection

Impact of Presurgical Mild Acute Respiratory Distress Syndrome on Surgical Mortality After Surgical Repair of Acute Type A Aortic Dissection

Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery

Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection

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