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Yu W, Liang Y, Gao J, Xiong J. Study on risk factors and treatment strategies of hypoxemia after acute type a aortic dissection surgery. J Cardiothorac Surg 2024; 19:273. [PMID: 38702812 PMCID: PMC11067146 DOI: 10.1186/s13019-024-02775-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
Acute type A aortic dissection is a life-threatening cardiovascular disease characterized by rapid onset and high mortality. Emergency surgery is the preferred and reliable treatment option. However, postoperative complications significantly impact patient prognosis. Hypoxemia, a common complication, poses challenges in clinical treatment, negatively affecting patient outcomes and increasing the risk of mortality. Therefore, it is crucial to study and comprehend the risk factors and treatment strategies for hypoxemia following acute type A aortic dissection to facilitate early intervention.
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Affiliation(s)
- Wenbo Yu
- The First Clinical Medical College of Gannan Medical University, Ganzhou, 341000, China
| | - Yuan Liang
- The First Clinical Medical College of Gannan Medical University, Ganzhou, 341000, China
| | - Jianfeng Gao
- The First Clinical Medical College of Gannan Medical University, Ganzhou, 341000, China
| | - Jianxian Xiong
- First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China.
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Xie LF, Han X, Xie YL, He J, Wu QS, Qiu ZH, Chen LW. A Predictive Model for Prolonged Mechanical Ventilation After Triple-Branched Stent Graft for Acute Type A Aortic Dissection. J Surg Res 2024; 296:66-77. [PMID: 38219508 DOI: 10.1016/j.jss.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/13/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION The aim of this study is to develop a model for predicting the risk of prolonged mechanical ventilation (PMV) following surgical repair of acute type A aortic dissection (AAAD). METHODS We retrospectively collected clinical data from 381 patients with AAAD who underwent emergency surgery. Clinical features variables for predicting postoperative PMV were selected through univariate analysis, least absolute shrinkage and selection operator regression analysis, and multivariate logistic regression analysis. A risk prediction model was established using a nomogram. The model's accuracy and reliability were evaluated using the area under the curve of the receiver operating characteristic curve and the calibration curve. Internal validation of the model was performed using bootstrap resampling. The clinical applicability of the model was assessed using decision curve analysis and clinical impact curve. RESULTS Among the 381 patients, 199 patients (52.2%) experienced postoperative PMV. The predictive model exhibited good discriminative ability (area under the curve = 0.827, 95% confidence interval: 0.786-0.868, P < 0.05). The calibration curve confirmed that the predicted outcomes of the model closely approximated the ideal curve, indicating agreement between the predicted and actual results (with an average absolute error of 0.01 based on 1000 bootstrap resampling). The decision curve analysis curve demonstrated that the model has significant clinical value. CONCLUSIONS The nomogram model established in this study can be used to predict the risk of postoperative PMV in patients with AAAD. It serves as a practical tool to assist clinicians in adjusting treatment strategies promptly and implementing targeted therapeutic measures.
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Affiliation(s)
- Lin-Feng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Xu Han
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Yu-Ling Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Jian He
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Qing-Song Wu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Zhi-Huang Qiu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China.
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Wu Q, Lin Q, Xie L, Qiu Z, Chen L. High summation of preoperative and postoperative Interleukin-6 levels predicts prolonged mechanical ventilation in patients with acute DeBakey type I aortic dissection: A single center retrospective study. Heliyon 2023; 9:e15465. [PMID: 37123919 PMCID: PMC10130200 DOI: 10.1016/j.heliyon.2023.e15465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023] Open
Abstract
Objective This study aimed to investigate the predictive effect of preoperative and postoperative interleukin-6 (IL-6) levels on the duration of mechanical ventilation in patients with acute DeBakey Type I aortic dissection (I-AAD) after emergency surgery. Methods We retrospectively enrolled 381 patients with I-AAD who underwent surgery in our hospital, between June 2018 and June 2022. Patients were divided into two groups according to whether prolonged mechanical ventilation (PMV) occurred after surgery. The baseline data, biochemical indicators at admission, surgical data, biochemical indicators at postoperative 6 h, and the postoperative data of the two groups were recorded and analyzed. Results The PMV group comprised 199 patients, and the non-PMV group 182. The postoperative in-hospital mortality was different between the two groups (11.1% vs. 3.3%, p = 0.004). The length of intensive care unit and hospitalization time in the PMV group were significantly longer than those in the non-PMV group. Multiple regression analysis showed postoperative IL-6 (post-IL-6) ≥67.1 pg/mL and summation of preoperative and postoperative IL-6 (total IL-6) ≥83.4 pg/mL were associated risk factors for PMV [odds ratio (OR) 3.259, 95% confidence interval (CI) 1.922-5.524, p < 0.001], [(OR) 4.515, 95% CI 2.241-9.098, p < 0.001]. Furthermore, determined by the receiver operating characteristics(ROC) curve, the cut-off point was total IL-6 ≥83.4 pg/mL (area under curve(AUC) = 0.825). The sensitivity and specificity of predicting postoperative PMV of patients with I-AAD were 91.5% and 78.2%, respectively (95% CI 0.782-0.868, p < 0.001). Conclusion For predicting postoperative PMV in patients with I-AAD, post IL-6 ≥67.1 pg/mL is potentially valuable and summation of preoperative and postoperative IL-6 (total IL-6) ≥83.4 pg/mL has a more pronounced predictive value.
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Affiliation(s)
- Qingsong Wu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Qinghua Lin
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Linfeng Xie
- Fujian Medical University, Fuzhou, Fujian, PR China
| | - Zhihuang Qiu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, PR China
- Key Laboratory of Cardio-Thoracic Surgery Fujian Medical University, Fujian Province University, Fuzhou, Fujian, PR China
- Corresponding author. Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29, Fuzhou, Fujian, 350001, PR China.
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Xie Q, Li C, Zhong Y, Luo C, Guo R, Liu Y, Zheng J, Ge Y, Sun L, Zhu J. Blood Transfusion Predicts Prolonged Mechanical Ventilation in Acute Stanford Type A Aortic Dissection Undergoing Total Aortic Arch Replacement. Front Cardiovasc Med 2022; 9:832396. [PMID: 35498041 PMCID: PMC9053570 DOI: 10.3389/fcvm.2022.832396] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis research aimed to evaluate the impacts of transfusing packed red blood cells (pRBCs), fresh frozen plasma (FFP), or platelet concentrate (PC) on postoperative mechanical ventilation time (MVT) in patients with acute Stanford type A aortic dissection (ATAAD) undergoing after total arch replacement (TAR).MethodsThe clinical data of 384 patients with ATAAD after TAR were retrospectively collected from December 2015 to October 2017 to verify whether pRBCs, FFP, or PC transfusion volumes were associated with postoperative MVT. The logistic regression was used to assess whether blood products were risk factors for prolonged mechanical ventilation (PMV) in all three endpoints (PMV ≥24 h, ≥48 h, and ≥72 h).ResultsThe mean age of 384 patients was 47.6 ± 10.689 years, and 301 (78.39%) patients were men. Median MVT was 29.5 (4–574) h (h), and 213 (55.47%), 136 (35.42%), and 96 (25.00%) patients had PMV ≥24 h, ≥48 h, and ≥72 h, respectively. A total of 36 (9.38%) patients did not have any blood product transfusion, the number of patients with transfusion of pRBCs, FFP, and PC were 334 (86.98%), 286 (74.48%), and 189 (49.22%), respectively. According to the multivariate logistic regression of three PMV time-endpoints, age was a risk factor [PMV ≥ 24 h odds ratio (ORPMV≥24) = 1.045, p = 0.005; ORPMV≥48 = 1.060, p = 0.002; ORPMV≥72 = 1.051, p = 0.011]. pRBC transfusion (ORPMV≥24 = 1.156, p = 0.001; ORPMV≥48 = 1.156, p < 0.001; ORPMV≥72 = 1.135, p ≤ 0.001) and PC transfusion (ORPMV≥24 = 1.366, p = 0.029; ORPMV≥48 = 1.226, p = 0.030; ORPMV≥72 = 1.229, p = 0.011) were independent risk factors for PMV. FFP had no noticeable effect on PMV [ORPMV≥48 = 0.999, 95% confidence interval (CI) 0.998–1.000, p = 0.039; ORPMV≥72 = 0.999, 95% CI: 0.998–1.000, p = 0.025].ConclusionsIn patients with ATAAD after TAR, the incidence of PMV was very high. Blood products transfusion was closely related to postoperative mechanical ventilation time. pRBC and PC transfusions and age increased the incidence of PMV at all three endpoints.
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Lin L, Lin Y, Peng Y, Huang X, Zhang X, Chen L, Li S. Admission Hyperglycemia in Acute Type A Aortic Dissection Predicts for a Prolonged Duration of Mechanical Ventilation. Int Heart J 2022; 63:106-112. [DOI: 10.1536/ihj.21-485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lingyu Lin
- School of Nursing, Fujian Medical University
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital
| | - Yanchun Peng
- Department of Cardiac Surgery, Fujian Medical University Union Hospital
| | - Xizhen Huang
- Department of Cardiac Surgery, Fujian Medical University Union Hospital
| | | | - Liangwan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital
| | - Sailan Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital
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Xi X, Chen Y, Ma WG, Xie J, Liu YM, Zhu JM, Gong M, Zhu GF, Sun LZ. Is obstructive sleep apnoea associated with hypoxaemia and prolonged ICU stay after type A aortic dissection repair? A retrospective study in Chinese population. BMC Cardiovasc Disord 2021; 21:421. [PMID: 34488643 PMCID: PMC8422665 DOI: 10.1186/s12872-021-02226-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background Although obstructive sleep apnoea (OSA) is prevalent among patients with aortic dissection, its prognostic impact is not yet determined in patients undergoing major vascular surgery. We aimed to investigate the association of OSA with hypoxaemia and with prolonged intensive care unit (ICU) stay after type A aortic dissection (TAAD) repair. Methods This retrospective study continuously enrolled 83 patients who underwent TAAD repair from January 1 to December 31, 2018. OSA was diagnosed by sleep test and defined as an apnoea hypopnea index (AHI) of ≥ 15/h, while an AHI of > 30/h was defined severe OSA. Hypoxaemia was defined as an oxygenation index (OI) of < 200 mmHg. Prolonged ICU stay referred to an ICU stay of > 72 h. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of postoperative OI for prolonged ICU stay. Multivariate logistic regression was performed to assess the association of OSA with hypoxaemia and prolonged ICU stay. Results A total of 41 (49.4%) patients were diagnosed with OSA using the sleep test. Hypoxaemia occurred postoperatively in 56 patients (67.5%). Postoperatively hypoxaemia developed mostly in patients with OSA (52.4% vs. 83.0%, p = 0.003), and particularly in those with severe OSA (52.4% vs. 90.5%, p = 0.003). The postoperative OI could fairly predict a prolonged ICU stay (area under the receiver-operating characteristic curve, 0.72; 95% confidence intervals [CI] 0.60–0.84; p = 0.002). Severe OSA was associated with both postoperative hypoxaemia (odds ratio [OR] 6.65; 95% CI 1.56–46.26, p = 0.008) and prolonged ICU stay (OR 5.58; 95% CI 1.54–20.24, p = 0.009). Conclusions OSA was common in patients with TAAD. Severe OSA was associated with postoperative hypoxaemia and prolonged ICU stay following TAAD repair.
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Affiliation(s)
- Xin Xi
- Sleep Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029, China
| | - Yu Chen
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiang Xie
- Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029, China.
| | - Yong-Min Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ming Gong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guang-Fa Zhu
- Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Ge M, Wang Z, Chen T, Cheng Y, Ye J, Lu L, Chen C, Wang D. Risk factors for and outcomes of prolonged mechanical ventilation in patients received DeBakey type I aortic dissection repairment. J Thorac Dis 2021; 13:735-742. [PMID: 33717545 PMCID: PMC7947516 DOI: 10.21037/jtd-20-2736] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background This study aimed to identify risk factors for prolonged mechanical ventilation (PMV) and its association with disease prognosis following acute DeBakey type I aortic dissection surgery. Methods A total of 582 patients who received emergency surgery for acute DeBakey type I aortic dissection from 2014 to 2018 were enrolled in this study. Mechanical ventilation period after surgery longer than 48 hours was defined as postoperative PMV. Multiple logistic regression analysis was used to identify risk factors for PMV. This study also compared short- and long-term outcomes in patients who developed PMV with patients who did not develop this complication. To identify and compare long-term cumulative survival rate, Kaplan-Meier survival curve was plotted. Results Among all enrolled patients, 259 (44.5%) received PMV treatment. Our data suggested that the length of intensive care unit and hospital stay were longer for patients who received PMV treatment. Thirty-day mortality was also higher in patients with PMV than in patients without PMV. Elevated leukocyte count and increased serum cystatin C level upon admission, lower preoperative platelet count and longer cardiopulmonary bypass (CPB) duration were identified as risk factors for PMV. Interestingly, our data suggested that there was no significant difference of survival rate between patients with or without PMV history. Conclusions PMV after DeBakey type I aortic dissection repair surgery was a common complication and associated with increased short-term mortality rate but did not affect long-term mortality rate. Elevated preoperative leukocyte count, increased preoperative serum cystatin C level, lower preoperative platelet count and longer CPB duration were risk factors for PMV.
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Affiliation(s)
- Min Ge
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhigang Wang
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Tao Chen
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yongqing Cheng
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiaxin Ye
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lichong Lu
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Cheng Chen
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Dongjin Wang
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Wang Z, Ge M, Chen T, Chen C, Zong Q, Lu L, Li K, Wang D. Risk factors and long-term outcomes of elderly patients complicating with acute kidney injury after type A acute aortic dissection surgery: a retrospective study. J Thorac Dis 2020; 12:5833-5841. [PMID: 33209415 PMCID: PMC7656361 DOI: 10.21037/jtd-20-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background To identify risk factors and long-term outcomes for acute kidney injury (AKI) in elderly patients who underwent type A acute aortic dissection (TA-AAD) emergency surgeries. Methods This retrospective study enrolled 214 consecutive patients who underwent TA-AAD emergency surgeries between January 2014 to December 2018 in Nanjing Drum Tower hospital. The diagnosis of AKI was made based on the Kidney Disease: Improving Global Outcomes definition (KDIGO) criteria. Multivariable regression analysis was performed to identify risk factors for postoperative AKI. Kaplan-Meier curves were generated to compare the long-term outcomes between patients with and without AKI complication after TA-AAD surgeries. Results Among all enrolled patients, 114 (53.3%) developed AKI during postoperative period. The median age of patients with or without AKI was 68.0 (64.0, 74.0) and 66.0 (62.0, 72.8) years respectively. Renal replacement therapy (RRT) was required in 43 patients (20.1%). The 30-day mortality rate was 21.5% in all enrolled patients with 26.3% in AKI group and 16.0% in non-AKI group (P=0.067) respectively. Longer mechanical ventilation duration was identified as the only independent risk factor for developing AKI by multivariable logistic regression analysis. In addition, our data suggested that the long-term cumulative survival rate was different between two groups. Conclusions Postoperative AKI after TA-AAD surgeries was common and associated with worsened long-term mortality in elderly patients. Longer postoperative mechanical ventilation duration was identified as the only independent risk factor for the development of AKI.
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Affiliation(s)
- Zhigang Wang
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Min Ge
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Tao Chen
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Cheng Chen
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qiuyan Zong
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lichong Lu
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Kunsheng Li
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Dongjin Wang
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Maisat W, Siriratwarangkul S, Charoensri A, Wongkornrat W, Lapmahapaisan S. Perioperative risk factors for delayed extubation after acute type A aortic dissection surgery. J Thorac Dis 2020; 12:4796-4804. [PMID: 33145052 PMCID: PMC7578465 DOI: 10.21037/jtd-20-742] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Delayed extubation after cardiac surgery is associated with high morbidity and mortality, increased intensive care unit length of stay, and healthcare cost. Acute type A aortic dissection (ATAAD) generally results in prolonged mechanical ventilation due to the complexity of surgical management and some postoperative complications. This study aimed to elucidate the perioperative risk factors for delayed extubation in patients undergoing ATAAD surgery. Methods A retrospective cohort study including 239 patients who were diagnosed with ATAAD and underwent emergency surgery from October 2004 to January 2018 was performed. The potential perioperative risk factors for delayed extubation were collected. This study defined delayed extubation as the time to commence extubation being greater than 48 hours. The clinical data were analyzed with univariate and multivariate analyses to identify risk factors for delayed extubation following ATAAD surgery. Results The incidence of delayed extubation was 48.5% (n=116). Multiple logistic regression analysis showed perioperative risk factors for delayed extubation included preoperative cardiac tamponade [odds ratio (OR) 3.94, 95% confidence interval (CI) 1.39–11.17, P=0.010], central arterial cannulation (ascending aorta and proximal aortic arch) for cardiopulmonary bypass (CPB) (OR 4.04, 95% CI: 1.03–15.91, P=0.046), postoperative stroke (OR 10.58, 95% CI: 2.65–42.25, P=0.001), postoperative renal dysfunction that required temporary hemodialysis (OR 6.60 95% CI: 1.97–22.11, P=0.002), and re-exploration to stop bleeding (OR 2.65, 95% CI: 1.00–6.99, P=0.050). Conclusions Preoperative cardiac tamponade, central arterial cannulation for CPB, postoperative stroke, postoperative renal dysfunction that required temporary hemodialysis, and re-exploration to stop bleeding are perioperative risk factors for delayed extubation. Identification of the potential risk factors for delayed extubation may help optimize the perioperative management and improve postoperative outcomes of patients undergoing ATAAD surgery.
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Affiliation(s)
- Wiriya Maisat
- Department of Anesthesiology, Department of surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasiya Siriratwarangkul
- Department of Anesthesiology, Department of surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apiporn Charoensri
- Department of Anesthesiology, Department of surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanchai Wongkornrat
- Division of Cardiothoracic surgery, Department of surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saowaphak Lapmahapaisan
- Department of Anesthesiology, Department of surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Zhang CH, Ma WG, Zhong YL, Ge YP, Li CN, Qiao ZY, Liu YM, Zhu JM, Sun LZ. Management of acute type A aortic dissection during COVID-19 outbreak: Experience from Anzhen. J Card Surg 2020; 36:1659-1664. [PMID: 32939857 DOI: 10.1111/jocs.15041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We seek to report our management protocol and early outcomes of acute type A aortic dissection (ATAAD) repair during the early phase of coronavirus disease 2019 (COVID-19). METHODS From January 23 to April 30, 2020, we performed ATAAD repair for 33 patients, including three with pregnancy-related TAADs. Confirmation of COVID-19 depended on the results of two nucleic acid tests and pulmonary computed tomography scan. Based on testing results and hemodynamic stability, patients were triaged to an isolated intensive care unit or negative pressure operating room for emergency surgery. RESULTS Mean age 50.2 ± 13.3 years and 20 were male (60.1%) and 8 patients were febrile (>37.3°C; 24.2%) and 17 were lymphopenic (51.5%). No patient was excluded from COVID-19 infection preoperatively. Extensive aortic repair with total arch replacement (TAR) was performed in 24 (72.7%), and limited proximal repair in 9 patients (27.3%). Cardiopulmonary bypass and cross-clamp times averaged 177 ± 34 and 88 ± 20 min for TAR, and 150 ± 30 and 83 ± 18 min for hemiarch, respectively. The mean operation time was 410 ± 68.3 min. Operative mortality was 6.1% (2/33). Complications included reintubation in four (12.1%), acute kidney failure in two (6.1%), and cerebral infarction in one (3.0%). No paraplegia nor re-exploration for bleeding occurred. COVID-19 was excluded in 100% eventually. No nosocomial infection occurred. Nor did any patient/surgical staff develop fever or test positive during the study period. CONCLUSIONS The results of this study show that our management protocol based on testing results and hemodynamic stability in patients with ATAAD during the COVID-19 pandemic was effective and achieved favorable early surgical outcomes.
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Affiliation(s)
- Chen-Han Zhang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yong-Liang Zhong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yi-Peng Ge
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Cheng-Nan Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zhi-Yu Qiao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yong-Min Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Ma WG, Chen Y, Zhang W, Li Q, Li JR, Zheng J, Liu YM, Zhu JM, Sun LZ. Extended repair for acute type A aortic dissection: long-term outcomes of the frozen elephant trunk technique beyond 10 years. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:292-300. [DOI: 10.23736/s0021-9509.20.11293-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Jin M, Ma WG, Liu S, Zhu J, Sun L, Lu J, Cheng W. Predictors of Prolonged Mechanical Ventilation in Adults After Acute Type-A Aortic Dissection Repair. J Cardiothorac Vasc Anesth 2017; 31:1580-1587. [DOI: 10.1053/j.jvca.2017.03.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 01/23/2023]
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13
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Clendenen N, Weitzel N. Predictors of Prolonged Mechanical Ventilation in Adults After Acute Type-A Aortic Dissection Repair-Implications for the Future. J Cardiothorac Vasc Anesth 2017; 31:1562-1563. [PMID: 28864159 DOI: 10.1053/j.jvca.2017.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Nathan Clendenen
- Department of Anesthesiology University of Colorado Denver School of Medicine Aurora, CO
| | - Nathaen Weitzel
- Department of Anesthesiology University of Colorado Denver School of Medicine Aurora, CO
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