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Wang X, Ma J, Lin D, Bai Y, Zhang D, Jia X, Gao J. MiR-145-5p reduced ANG II-induced ACE2 shedding and the inflammatory response in alveolar epithelial cells by targeting ADAM17 and inhibiting the AT1R/ADAM17 pathway. Eur J Pharmacol 2024; 971:176392. [PMID: 38365107 DOI: 10.1016/j.ejphar.2024.176392] [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: 12/22/2022] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Abstract
The excessive elevation of angiotensin II (ANG II) is closely associated with the occurrence and development of aortic dissection (AD)-related acute lung injury (ALI), through its binding to angiotensin II receptor type I (AT1R). MiR-145-5p is a noncoding RNA that can be involved in a variety of cellular physiopathological processes. Transfection with miR-145-5p was found to downregulated the expression of A disintegrin and metalloprotease 17 (ADAM17) and reduced the levels of angiotensin-converting enzyme 2 (ACE2) in lung tissue, while concurrently increasing plasma ACE2 levels in the AD combined with ALI mice. ADAM17 was proved to be a target of miR-145-5p. Transfection with miR-145-5p decreased the shedding of ACE2 and alleviated the inflammatory response induced by ANG II through targeting ADAM17 and inhibiting the AT1R/ADAM17 pathway in A549 cells. In conclusion, our present study demonstrates the role and mechanism of miR-145-5p in alleviating ANG II-induced acute lung injury, providing a new insight into miRNA therapy for reducing lung injury in patients with aortic dissection.
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Affiliation(s)
- Xu'an Wang
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China; Department of Anesthesiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jun Ma
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
| | - Duomao Lin
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yang Bai
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China; Department of Anesthesiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Dongni Zhang
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xiaotong Jia
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Junwei Gao
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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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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Wang L, Pang X, Ding S, Pei K, Li Z, Wan J. Effect of postoperative oxygen therapy regimen modification on oxygenation in patients with acute type A aortic dissection. Heliyon 2024; 10:e29108. [PMID: 38638990 PMCID: PMC11024556 DOI: 10.1016/j.heliyon.2024.e29108] [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: 01/02/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/20/2024] Open
Abstract
Objective In this study, we investigated the effect of various oxygen therapy regimens on oxygenation in patients with acute type A aortic dissection (AAD). Methods A quasi-randomized controlled trial was conducted, in which patients with AAD hospitalized for surgery from June to September 2021 were assigned to the control group (patients received conventional oxygen therapy after postoperative mechanical ventilation, weaning, and extubation) and those who were admitted from October to December 2021 were assigned to the observation group [patients underwent optimally adjusted therapy based on the treatment of the control group, which mainly included prioritized elevation of positive end-expiratory pressure (PEEP) and restricted use of the fraction of inspired oxygen (FiO2)].The postoperative oxygenation index, blood gas analysis, and duration of mechanical ventilation were compared between the two groups. Results There were significant differences in oxygenation observed at 2 h postoperatively between the groups. 12, 24, and 72 h postoperatively, the oxygenation index varied significantly between the two groups. There were statistically significant differences in the time effects of the oxygenation index and PaO2 between the two groups, as well as significant differences in the length of stay in the intensive care unit. Conclusion For the postoperative care of patients with AAD, it is suggested that the minimum FiO2 required for oxygenation of patients be maintained. In addition, it is possible to enhance PEEP as a priority when PaO2 is low.
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Affiliation(s)
- Li Wang
- Department of Hospital Infection Control, The Second Hospital of Shandong University, Jinan, 250033, PR China
| | - Xinyan Pang
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan, 250033, PR China
| | - Shouluan Ding
- Institute of Medicine Sciences, The Second Hospital of Shandong University, Jinan, 250033, PR China
| | - Ke Pei
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan, 250033, PR China
| | - Zijia Li
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan, 250033, PR China
| | - Jianhong Wan
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan, 250033, PR China
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Liu Q, Guan Y, Yang X, Jiang Y, Hei F. Perioperative oxygenation impairment related to type a aortic dissection. Perfusion 2024:2676591231224997. [PMID: 38174389 DOI: 10.1177/02676591231224997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Type A aortic dissection (TAAD) is a life-threatening disease with high mortality and poor prognosis, usually treated by surgery. There are many complications in its perioperative period, one of which is oxygenation impairment (OI). As a common complication of TAAD, OI usually occurs throughout the perioperative period of TAAD and requires prolonged mechanical ventilation (MV) and other supportive measures. The purpose of this article is to review the risk factors, mechanisms, and treatments of type A aortic dissection-related oxygenation impairment (TAAD-OI) so as to improve clinicians' knowledge about it. Among risk factors, elevated body mass index (BMI), prolonged extracorporeal circulation (ECC) duration, higher inflammatory cells and stored blood transfusion stand out. A reduced occurrence of TAAD-OI can be achieved by controlling these risk factors such as suppressing inflammatory response by drugs. As for its mechanism, it is currently believed that inflammatory signaling pathways play a major role in this process, including the HMGB1/RAGE signaling pathway, gut-lung axis and macrophage, which have been gradually explored and are expected to provide evidences revealing the specific mechanism of TAAD-OI. Numerous treatments have been investigated for TAAD-OI, such as nitric oxide (NO), continuous pulmonary perfusion/inflation, ulinastatin and sivelestat sodium, immunomodulation intervention and mechanical support. However, these measures are all aimed at postoperative TAAD-OI, and not all of the therapies have shown satisfactory effects. Treatments for preoperative TAAD-OI are not currently available because it is difficult to correct OI without correcting the dissection. Therefore, the best solution for preoperative TAAD-OI is to operate as soon as possible. At present, there is no specific method for clinical application, and it relies more on the experience of clinicians or learns from treatments of other diseases related to oxygenation disorders. More efforts should be made to understand its pathogenesis to better improve its treatments in the future.
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Affiliation(s)
- Qindong Liu
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yulong Guan
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofang Yang
- Department of Extracorporeal Circulation and Mechanical Circulation Assistants, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu Jiang
- Department of Extracorporeal Circulation and Mechanical Circulation Assistants, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Feilong Hei
- Department of Extracorporeal Circulation and Mechanical Circulation Assistants, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Fei Z, Liu H, Liu X, Hu Z. Effect of pre-operative hypoxemia on the occurrence and outcomes of post-operative ARDS in Stanford type a aortic dissection patients. Respir Res 2023; 24:161. [PMID: 37330514 DOI: 10.1186/s12931-023-02457-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/22/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Pre-operative and post-operative hypoxemia are frequent complications of Stanford type A aortic dissection (AAD). This study explored the effect of pre-operative hypoxemia on the occurrence and outcome of post-operative acute respiratory distress syndrome (ARDS) in AAD. METHOD A total of 238 patients who underwent surgical treatment for AAD between 2016 and 2021 were enrolled. Logistic regression analysis was conducted to investigate the effect of pre-operative hypoxemia on post-operative simple hypoxemia and ARDS. Post-operative ARDS patients were divided into pre-operative normal oxygenation group and pre-operative hypoxemia group that were compared for clinical outcomes. Post-operative ARDS patients with pre-operative normal oxygenation were classified as the real ARDS group. Post-operative ARDS patients with pre-operative hypoxemia, post-operative simple hypoxemia, and post-operative normal oxygenation were classified as the non-ARDS group. Outcomes of real ARDS and non-ARDS groups were compared. RESULT Logistic regression analysis showed that pre-operative hypoxemia was positively associated with the risk of post-operative simple hypoxemia (odds ratios (OR) = 4.81, 95% confidence interval (CI): 1.67-13.81) and post-operative ARDS (OR = 8.514, 95% CI: 2.64-27.47) after adjusting for the confounders. The post-operative ARDS with pre-operative normal oxygenation group had significantly higher lactate, APACHEII score and longer mechanical ventilation time than the post-operative ARDS with pre-operative hypoxemia group (P < 0.05). Pre-operative the risk of death within 30 days after discharge was slightly higher in ARDS patients with pre-operative normal oxygenation than in ARDS patients with pre-operative hypoxemia, but there was no statistical difference(log-rank test, P = 0.051). The incidence of AKI and cerebral infarction, lactate, APACHEII score, mechanical ventilation time, intensive care unit and post-operative hospital stay, and mortality with 30 days after discharge were significantly higher in the real ARDS group than in the non-ARDS group (P < 0.05). After adjusting for confounding factors in the Cox survival analysis, the risk of death within 30 days after discharge was significantly higher in the real ARDS group than in the non-ARDS group (hazard ratio(HR): 4.633, 95% CI: 1.012-21.202, P < 0.05). CONCLUSION Preoperative hypoxemia is an independent risk factor for post-operative simple hypoxemia and ARDS. Post-operative ARDS with pre-operative normal oxygenation was the real ARDS, which was more severe and associated with a higher risk of death after surgery.
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Affiliation(s)
- Zhonghua Fei
- Cardiac Intensive Care Unit, Affiliated Hospital of Jining Medical University, Jining, 272000, China
| | - Hongsheng Liu
- Cardiac Intensive Care Unit, Affiliated Hospital of Jining Medical University, Jining, 272000, China
| | - Xinmei Liu
- Cardiac Intensive Care Unit, Affiliated Hospital of Jining Medical University, Jining, 272000, China
| | - Zhansheng Hu
- Suzhou Medical College of Soochow University, Suzhou, 215123, China.
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000, China.
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Guan X, Li L, Li J, Jiang W, Li H, Wang X, Han L, Liu Y, Gong M, Zhang H. High preoperative bradykinin level is a risk factor for severe postoperative hypoxaemia in acute aortic dissection surgery. Exp Physiol 2023; 108:683-691. [PMID: 36934370 PMCID: PMC10988494 DOI: 10.1113/ep091054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/28/2023] [Indexed: 03/20/2023]
Abstract
NEW FINDINGS What is the central question of this study? Hypoxaemia can lead to increased postoperative mortality in patients: what are the independent risk factors for severe hypoxaemia after acute Stanford type A aortic dissection? What is the main finding and its importance? Severe postoperative hypoxaemia was found in 36.4% of patients, and it was determined that high preoperative bradykinin levels and increased BMI were independent predictors of severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. For obese patients with high preoperative bradykinin levels, more attention should be paid to preventing severe postoperative hypoxaemia. ABSTRACT Severe hypoxaemia after cardiac surgery is associated with serious complications and a high risk of mortality. The purpose of this study is to investigate the independent risk factors of severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. We collected 77 patients with acute Stanford type A aortic dissection who underwent surgical treatment. The primary outcome was severe postoperative hypoxaemia (PaO2 /FiO2 ≤ 100 mmHg), and a multivariate logistic regression analysis was performed to assess the independent predictors of risk for this. A mixed-effects analysis of variance model and a receiver operating characteristic (ROC) curve were generated to evaluate the predictive probabilities of risk factors for severe postoperative hypoxaemia. A total of 36.4% of patients developed severe postoperative hypoxaemia. The multivariate logistic regression analysis identified high preoperative bradykinin level (odds ratio (OR) = 55.918, P < 0.001) and increased body mass index (BMI; OR = 1.292, P = 0.032) as independent predictors of severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. The mixed-effect analysis of variance model and ROC curve indicated that high preoperative bradykinin level and BMI were significant predictors of severe postoperative hypoxaemia (area under the ROC curve = 0.834 and 0.764, respectively). High preoperative bradykinin levels and obesity were independent risk factors for severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. For obese patients with high levels of bradykinin before surgery, clinicians should actively take measures to block bradykinin-mediated inflammatory reactions.
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Affiliation(s)
- XinLiang Guan
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineCapital Medical UniversityBeijingChina
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
- Beijing Laboratory for Cardiovascular Precision MedicineKey Laboratory of Medical Engineering for Cardiovascular DiseaseBeijingChina
| | - Lei Li
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineCapital Medical UniversityBeijingChina
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
- Beijing Laboratory for Cardiovascular Precision MedicineKey Laboratory of Medical Engineering for Cardiovascular DiseaseBeijingChina
| | - JinZhang Li
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineCapital Medical UniversityBeijingChina
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
- Beijing Laboratory for Cardiovascular Precision MedicineKey Laboratory of Medical Engineering for Cardiovascular DiseaseBeijingChina
| | - WenJian Jiang
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineCapital Medical UniversityBeijingChina
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
- Beijing Laboratory for Cardiovascular Precision MedicineKey Laboratory of Medical Engineering for Cardiovascular DiseaseBeijingChina
| | - HaiYang Li
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineCapital Medical UniversityBeijingChina
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
- Beijing Laboratory for Cardiovascular Precision MedicineKey Laboratory of Medical Engineering for Cardiovascular DiseaseBeijingChina
| | - XiaoLong Wang
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineCapital Medical UniversityBeijingChina
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
- Beijing Laboratory for Cardiovascular Precision MedicineKey Laboratory of Medical Engineering for Cardiovascular DiseaseBeijingChina
| | - Lu Han
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineCapital Medical UniversityBeijingChina
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
- Beijing Laboratory for Cardiovascular Precision MedicineKey Laboratory of Medical Engineering for Cardiovascular DiseaseBeijingChina
| | - YuYong Liu
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineCapital Medical UniversityBeijingChina
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
- Beijing Laboratory for Cardiovascular Precision MedicineKey Laboratory of Medical Engineering for Cardiovascular DiseaseBeijingChina
| | - Ming Gong
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineCapital Medical UniversityBeijingChina
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
- Beijing Laboratory for Cardiovascular Precision MedicineKey Laboratory of Medical Engineering for Cardiovascular DiseaseBeijingChina
| | - HongJia Zhang
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineCapital Medical UniversityBeijingChina
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
- Beijing Laboratory for Cardiovascular Precision MedicineKey Laboratory of Medical Engineering for Cardiovascular DiseaseBeijingChina
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Zhang C, Bai H, Lin G, Zhang Y, Zhang L, Chen X, Shi R, Zhang G, Fu Z, Xu Q. Association of preoperative monocyte/lymphocyte ratio with postoperative oxygenation impairment in patients with acute aortic syndrome. Int Immunopharmacol 2023; 118:110067. [PMID: 37028273 DOI: 10.1016/j.intimp.2023.110067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Postoperative oxygenation impairment represents a common complication in patients with the acute aortic syndrome (AAS). The study aimed to explore the relationship between inflammatory indicators and AAS patients with oxygenation impairment after operation. METHODS In this study, 330 AAS patients who underwent surgery were enrolled and divided into 2 groups based on postoperative oxygenation impairment (non-oxygenation impairment group and oxygenation impairment group). Regression analysis was performed to assess the relationship between inflammatory indicators and postoperative oxygenation impairment. A smooth curve and interaction analysis were further conducted. Stratified analysis was used according to preoperative monocyte/lymphocyte ratio (MLR) (Tertiles). RESULTS Multivariate analysis showed that preoperative MLR was independently related to oxygenation impairment after surgery in AAS patients (OR, 95% CI, P: 2.77, 1.10-7.00, 0.031). The smooth curve indicated the risk of postoperative oxygenation impairment was higher with the elevated preoperative MLR. Interaction analysis revealed that patients with AAS with high preoperative MLR who had coronary artery disease (CAD) had a higher risk of oxygenation impairment after operation. Moreover, stratified analysis was performed according to baseline MLR (Tertiles), and a higher baseline MLR level in AAS patients was correlated with a lower arterial oxygen tension (PaO2) / inspiratory oxygen fraction (FiO2) ratio perioperatively. CONCLUSIONS In AAS patients, preoperative MLR level was independently related to postoperative oxygenation impairment.
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Affiliation(s)
- Chiyuan Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, Hunan, China
| | - Hui Bai
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, Hunan, China
| | - Guoqiang Lin
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, Hunan, China
| | - Yanfeng Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, Hunan, China
| | - Lei Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, Hunan, China
| | - Xuliang Chen
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, Hunan, China
| | - Ruizheng Shi
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, Hunan, China
| | - Guogang Zhang
- Department of Cardiovascular Medicine, the Third Xiangya Hospital, Central South University, Tongzipo Rd 138, Changsha, Hunan, China
| | - Zuli Fu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, Hunan, China
| | - Qian Xu
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, Hunan, China.
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Hua LJ, Kong LX, Hu JN, Liu Q, Bao C, Liu C, Li ZL, Chen J, Xu SY. Perioperative Risk Factors for Post-operative Pneumonia after Type A Acute Aortic Dissection Surgery. Curr Med Sci 2023; 43:69-79. [PMID: 36334171 DOI: 10.1007/s11596-022-2659-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Type A acute aortic dissection (TAAAD) is a dangerous and complicated condition with a high death rate before hospital treatment. Patients who are fortunate to receive prompt surgical treatment still face high in-hospital mortality. A series of post-operative complications further affects the prognosis. Post-operative pneumonia (POP) also leads to great morbidity and mortality. This study aimed to identify the prevalence as well as the risk factors for POP in TAAAD patients and offer references for clinical decisions to further improve the prognosis of patients who survived the surgical procedure. METHODS The study enrolled 89 TAAAD patients who underwent surgical treatment in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, China from December 2020 to July 2021 and analyzed the perioperative data and outcomes of these patients. Logistic regression analyses were used to identify the risk factors for POP. RESULTS In the study, 31.5% of patients developed POP. Patients with POP had higher proportions of severe oxygenation damage, pneumothorax, reintubation, tracheotomy, renal replacement therapy, arrhythmia, gastrointestinal bleeding, and longer duration of mechanical ventilation, fever, ICU stay, and length of stay (all with P<0.05). The in-hospital mortality was 2.3%. Smoking, preoperative white blood cells, and intraoperative transfusion were the independent risk factors for POP in TAAAD. CONCLUSION Patients who underwent TAAAD surgery suffered poorer outcomes when they developed POP. Furthermore, patients with risk factors should be treated with caution.
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Affiliation(s)
- Li-Juan Hua
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lu-Xia Kong
- Department of Respiratory and Critical Care Medicine, Taikang Tongji (Wuhan) Hospital, Wuhan, 430050, China
| | - Jian-Nan Hu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qian Liu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chen Bao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chao Liu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zi-Ling Li
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun Chen
- Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shu-Yun Xu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Zhang X, Lv W, Liu X, Liu K, Yang S. Impact of shift work on surgical outcomes at different times in patients with acute type A aortic dissection: A retrospective cohort study. Front Cardiovasc Med 2022; 9:1000619. [PMID: 36386350 PMCID: PMC9650381 DOI: 10.3389/fcvm.2022.1000619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background To investigate the effect of shift work on surgical outcomes at different times in patients with acute type A aortic dissection (ATAAD). Materials and methods Patients with ATAAD who underwent total arch replacement at Qilu Hospital of Shandong University from January 2015 to March 2022 were retrospectively analyzed. All patients were managed according to the green channel emergency management strategy, and a professional cardiac team was arranged during off-hours. Based on surgery time and symptom onset to procedure time, the patients were divided into weekday, weekend and holiday groups; daytime and nighttime groups; intervention time ≤48 h and >48 h groups; working hours and off-hours groups. In-hospital mortality between these groups was compared. Results In total, 499 ATAAD patients underwent surgery within 7 days of symptom onset, and the in-hospital mortality rate was 10% (n = 50/499). Among the 499 patients, 320 (64.13%), 128 (25.65%) and 51 (10.22%) underwent surgery on weekdays, weekends and holidays, respectively. In-hospital mortality and 7-day mortality showed no significant difference among the three groups. Two hundred twenty-seven (45.5%) underwent daytime surgery, and 272 (54.5%) underwent nighttime surgery. Durations of ICU stay and hospital stay were significantly different between the two groups (P < 0.05). There was no significant differences in in-hospital mortality (9.2% vs. 10.7%) and 7-day mortality (4.4% vs. 6.6%). 221 patients (44.3%) and 278 patients (55.7%) were included in the intervention time ≤48 h and >48 h groups, respectively. Acute renal injury, ICU stay and hospital stay were significantly different (P < 0.05) whereas 7-day mortality (5.0% vs. 6.1%) and in-hospital mortality (8.6% vs. 11.1%) were not. Furthermore, 7-day (1.9% vs. 6.6%) and in-hospital mortality (11.1% vs. 9.8%) showed no difference between working hours group (n = 108) and off-hours group (n = 391). Cox regression analysis showed that postoperative acute renal injury (HR = 2.423; 95% CI, 1.214–4.834; P = 0.012), pneumonia (HR = 2.542; 95% CI, 1.186–5450; P = 0.016) and multiple organ dysfunction (HR = 11.200; 95% CI, 5.549–22.605; P = 0.001) were the main factors affecting hospital death in ATAAD patients. Conclusion Under the management of a professional cardiac surgery team with dedicated off-hours shifts, surgery time was not related to in-hospital mortality in ATAAD patients.
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Affiliation(s)
- Xiang Zhang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Weiwei Lv
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xin Liu
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Kai Liu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shaozhong Yang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- *Correspondence: Shaozhong Yang,
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10
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Zhang C, Bai H, Zhang Y, Deng Z, Zhang L, Chen X, Fu Z, Shi R, Zhang G, Xu Q, Lin G. Impact of body mass index on postoperative oxygenation impairment in patients with acute aortic syndrome. Front Physiol 2022; 13:955702. [PMID: 36117715 PMCID: PMC9470752 DOI: 10.3389/fphys.2022.955702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Oxygenation impairment is a common complication of acute aortic syndrome (AAS) patients after surgical repair. The aim of this study is to identify the relationship between body mass index (BMI) and the risk of postoperative oxygenation impairment in AAS patients. Methods: A total of 227 consecutive patients who were diagnosed as AAS and underwent surgical repair were recruited. They were divided into two groups based on the postoperative oxygenation impairment (non-oxygenation impairment group and oxygenation impairment group). Logistic regression was conducted to evaluate the association between BMI and the risk of oxygenation impairment after surgery. Dose-response curve and subgroup analysis were used to test the reliability of the results of regression analysis. A meta-analysis was then performed to further confirm these results using Pubmed, Embase, and Web of Science databases. Results: For the retrospective study, a significant association was observed after adjusting for a series of variables. BMI was significantly correlated with postoperative oxygenation impairment in patients with AAS (OR, 95% CI, P: 1.27, 1.17–1.46, 0.001). Compared with the normal weight group (18.5 kg/m2 ≤ BMI <23.0 kg/m2), patients with excessive BMI were at a higher risk of oxygenation impairment for the overweight group (23.0 kg/m2 ≤ BMI <25 kg/m2) and obesity group (BMI ≥25 kg/m2) (OR, 95% CI, P: 4.96, 1.62–15.15, 0.005; 9.51, 3.06–29.57, <0.001). The dose-response curve showed that the risk of oxygenation impairment after surgery increased with the increased BMI. Besides, subgroup analysis showed that AAS patients who have an excess weight with a TNF-α ≥ 8.1 pg/ml carried an excess risk of postoperative oxygenation impairment. For the meta-analysis, the pooled result also indicated that AAS patients with high BMI had a significantly increased risk of oxygenation impairment after surgery (OR, 95% CI, P: 1.40, 1.18–1.66, 0.001). Conclusion: Excessive BMI was an independent risk factor for AAS with postoperative oxygenation impairment.
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Affiliation(s)
- Chiyuan Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Bai
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanfeng Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhengyu Deng
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lei Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuliang Chen
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zuli Fu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ruizheng Shi
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guogang Zhang
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Xu
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Qian Xu, ; Guoqiang Lin,
| | - Guoqiang Lin
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Qian Xu, ; Guoqiang Lin,
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11
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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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12
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Möller CM, Ellmauer PP, Zeman F, Bitzinger D, Flörchinger B, Graf BM, Zausig YA. Postoperative acute respiratory dysfunction and the influence of antibiotics after acute type A aortic dissection surgery: A retrospective analysis. PLoS One 2021; 16:e0246724. [PMID: 33571258 PMCID: PMC7877985 DOI: 10.1371/journal.pone.0246724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/25/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Surgery for acute type A aortic dissection is associated with several perioperative complications, such as acute respiratory dysfunction (ARD). The aim of this study was to investigate perioperative risk factors involved in the development of ARD and whether antibiotic treatment has an impact. METHODS 243 patients underwent surgery for acute type A aortic dissection between 2008 and 2017. The patients were retrospectively divided into the ARD and NON-ARD group. ARD was defined as PaO2/FiO2 ≤ 200 mmHg (PF ratio) within 48 hours after surgery. All patients received either narrow- or broad-spectrum antibiotics. RESULTS After the exclusion of 42 patients, 201 patients were analyzed. The PF ratio of the ARD group was significantly lower than of the NON-ARD group within the first 7 days. ARD patients (n = 111) were significantly older (p = .031) and had a higher body mass index (BMI) (p = .017). ARD patients required longer postoperative ventilation (2493 vs. 4695 [min], p = .006) and spent more days in the intensive care unit (7.0 vs. 8.9 [days], p = .043) compared to NON-ARD. The mortality was significantly lower for ARD than for NON-ARD patients (p = .030). The incidence of pneumonia was independent of the antibiotic treatment regime (p = .391). Renal and neurological complication rate was higher in patients treated with broad-spectrum antibiotic. CONCLUSION ARD is the main complication (55%) that occurs approximately 24 hours after surgery for acute type A aortic dissection. The preoperative risk factors for ARD were higher age and increased BMI. Patients on broad-spectrum antibiotics did not show an improved postoperative outcome compared to patients with narrow-spectrum antibiotics.
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Affiliation(s)
- Christina M. Möller
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Peter-Paul Ellmauer
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Florian Zeman
- Center of Clinical Studies, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Diane Bitzinger
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Bernhard Flörchinger
- Department of Cardiac Surgery, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Bernhard M. Graf
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - York A. Zausig
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Bavaria, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine, Aschaffenburg-Alzenau Hospital, Aschaffenburg, Bavaria, Germany
- * E-mail: ,
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13
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Liu H, Liu S, Zaki A, Wang X, Cong S, Yang Y, Li J, Lai H, Sun Y, Wei L, Wang C. Quantifying the learning curve of emergent total arch replacement in acute type A aortic dissection. J Thorac Dis 2020; 12:4070-4081. [PMID: 32944318 PMCID: PMC7475536 DOI: 10.21037/jtd-20-912] [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: 12/20/2022]
Abstract
Background Acute type A aortic dissection with arch involvement is a life-threatening condition, which requires immediate surgical attention. Emergent total arch replacement and root reconstruction is a technically demanding operation with varying outcomes based on surgeon experience. The human factors in total arch replacement in the emergent setting have never been systematically investigated. The ability of surgeons with low volumes to achieve acceptable results in their start-up period is not known. Methods From January 2013 to December 2016, patients with acute type A aortic dissection who underwent emergent total arch replacement with three surgeons were enrolled. Basic characteristics, procedural and postoperative outcomes were collected. The time of critical surgical steps and operative mortality were calculated using descriptive statistics and cumulative SUM (CUSUM) analysis. Results A total of 300 patients (age 53.8±11.5 years, female 63, 21.0%) with acute type A aortic dissection underwent emergent total arch replacement. A total of 219 patients (73.0%) had root reinforcement, 295 patients (98.3%) underwent frozen elephant trunk repair. Mean circulatory arrest and cross-clamp times were 29.8±9.8 and 112.3±32.1 min, respectively. The operative mortality was 6.7%, the stroke rate was 4.0%. The mean length of postoperative ICU and hospital stays were 8.4±10.6 and 18.0±12.2 days, respectively. By CUSUM depictions, surgeons appeared to have different learning curves with regards to operative time. By CUSUM failure analysis on operative mortality, two newly appointed surgeons in their start-up period stayed in an acceptable range, while one senior surgeon with higher volumes experienced superior outcomes and better performance. Conclusions Although emergent total arch replacement for acute type A dissection is a complex scenario, surgeons well-trained in adult cardiac surgery are able to achieve acceptable results in their start-up period.
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Affiliation(s)
- Huan Liu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Cardiovascular Institution, Fudan University, Shanghai, China
| | - Shun Liu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Cardiovascular Institution, Fudan University, Shanghai, China
| | - Anthony Zaki
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Xiuwen Wang
- Department of Intensive Care Medicine of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Cardiovascular Institution, Fudan University, Shanghai, China
| | - Shuo Cong
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Cardiovascular Institution, Fudan University, Shanghai, China
| | - Ye Yang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Cardiovascular Institution, Fudan University, Shanghai, China
| | - Jun Li
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Cardiovascular Institution, Fudan University, Shanghai, China
| | - Hao Lai
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Cardiovascular Institution, Fudan University, Shanghai, China
| | - Yongxin Sun
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Cardiovascular Institution, Fudan University, Shanghai, China
| | - Lai Wei
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Cardiovascular Institution, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Cardiovascular Institution, Fudan University, Shanghai, China
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14
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Tian WZ, Er JX, Liu L, Chen QL, Han JG. Effects of Autologous Platelet Rich Plasma on Intraoperative Transfusion and Short-Term Outcomes in Total Arch Replacement (Sun's Procedure): A Prospective, Randomized Trial. J Cardiothorac Vasc Anesth 2019; 33:2163-2169. [PMID: 31060939 DOI: 10.1053/j.jvca.2019.02.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To observe the effect of collecting and retransfusing autologous platelet rich plasma (aPRP) on the amount of allogeneic blood usage in total arch replacement (Sun's surgery) and the outcomes 30 days after surgery. DESIGN A prospective, randomized trial. SETTING A tertiary university hospital specialized in cardiovascular diseases. PARTICIPANTS The study comprised 120 patients undergoing Sun's surgery for Stanford type A acute aortic dissection. INTERVENTIONS aPRP was harvested before incision and was re-transfused after heparin neutralization for patients in the treatment group. MEASUREMENTS AND MAIN RESULTS There was no significant difference in preoperative demographic data between the 2 study groups. Intraoperative transfusions of erythrocyte (p = 0.009), plasma (p = 0.017), cryoprecipitate (p = 0.002), and platelets (p < 0.001) in the treatment group were reduced significantly. In addition, less blood loss was observed in the treatment group (p = 0.002). The durations of postoperative mechanical ventilation (p = 0.029) and hospitalization (p = 0.002) of the treatment group were significantly shorter. There were no statistically significant differences in the length of intensive care unit stay, the incidence of complications, and mortality 30 days after surgery. CONCLUSION In total arch replacement (Sun's surgery), collecting and retransfusing aPRP reduced intraoperative transfusions of erythrocyte, plasma, and cryoprecipitate and decreased the duration of postoperative mechanical ventilation and hospitalization. This technique had no significant effect on the incidence of complications and mortality 30 days postoperatively.
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Affiliation(s)
- Wen-Zhi Tian
- Department of Anesthesiology, Tianjin Chest Hospital, Tianjin Cardiovascular Diseases Institute, Tianjin, China
| | - Jian-Xu Er
- Department of Anesthesiology, Tianjin Chest Hospital, Tianjin Cardiovascular Diseases Institute, Tianjin, China
| | - Liang Liu
- Department of Anesthesiology, Tianjin Chest Hospital, Tianjin Cardiovascular Diseases Institute, Tianjin, China
| | - Qing-Liang Chen
- Department of Cardio-Vascular Surgery, Tianjin Chest Hospital, Tianjin Cardiovascular Diseases Institute, Tianjin, China
| | - Jian-GeHan Han
- Department of Anesthesiology, Tianjin Chest Hospital, Tianjin Cardiovascular Diseases Institute, Tianjin, China.
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15
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Sarsam MAI. Type A aortic dissection: Are we any nearer to taming the beast? J Thorac Cardiovasc Surg 2018. [PMID: 29530569 DOI: 10.1016/j.jtcvs.2018.01.062] [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: 11/29/2022]
Affiliation(s)
- Mazin A I Sarsam
- Department of Cardiac Surgery, St. Georges Hospital, London, United Kingdom.
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16
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De Santo LS. Acute aortic dissection: The conundrum of severity of disease, extent of surgery and end-organ function. J Thorac Cardiovasc Surg 2018. [PMID: 29530568 DOI: 10.1016/j.jtcvs.2018.01.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Luca Salvatore De Santo
- University of Foggia, Foggia, Italy and Cardiac Surgery Unit, Casa di Cura Montevergine, GVM Care and Research, Mercogliano, Italy.
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