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van Paassen J, Hiemstra PS, van der Linden AC, de Jonge E, Zwaginga JJ, Klautz RJM, Arbous MS. MUC5AC concentrations in lung lavage fluids are associated with acute lung injury after cardiac surgery. Respir Res 2024; 25:117. [PMID: 38454475 PMCID: PMC10921709 DOI: 10.1186/s12931-024-02747-9] [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: 01/26/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
Heart surgery may be complicated by acute lung injury and adult respiratory distress syndrome. Expression and release of mucins MUC5AC and MUC5B in the lungs has been reported to be increased in acute lung injury. The aim of our study was to [1] investigate the perioperative changes of MUC5AC, MUC5B and other biomarkers in mini-bronchoalveolar lavage (minBAL), and [2] relate these to clinical outcomes after cardiac surgery. In this prospective cohort study in 49 adult cardiac surgery patients pre- and post-surgery non-fiberscopic miniBAL fluids were analysed for MUC5AC, MUC5B, IL-8, human neutrophil elastase, and neutrophils. All measured biomarkers increased after surgery. Perioperative MUC5AC-change showed a significant negative association with postoperative P/F ratio (p = 0.018), and a positive association with ICU stay (p = 0.027). In conclusion, development of lung injury after cardiac surgery and prolonged ICU stay are associated with an early increase of MUC5AC as detected in mini-BAL.
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Affiliation(s)
- Judith van Paassen
- Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, Leiden, B4-57, 2333 ZA, the Netherlands.
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Evert de Jonge
- Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, Leiden, B4-57, 2333 ZA, the Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert J M Klautz
- Department of Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - M Sesmu Arbous
- Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, Leiden, B4-57, 2333 ZA, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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2
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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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3
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Flower L, Arrowsmith JE, Bewley J, Cook S, Cooper G, Flower J, Greco R, Sadeque S, Madhivathanan PR. Management of acute aortic dissection in critical care. J Intensive Care Soc 2023; 24:409-418. [PMID: 37841293 PMCID: PMC10572474 DOI: 10.1177/17511437231162219] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Aortic dissections are associated with significant mortality and morbidity, with rapid treatment paramount. They are caused by a tear in the intimal lining of the aorta that extends into the media of the wall. Blood flow through this tear leads to the formation of a false passage bordered by the inner and outer layers of the media. Their diagnosis is challenging, with most deaths caused by aortic dissection diagnosed at post-mortem. Aortic dissections are classified by location and chronicity, with management strategies depending on the nature of the dissection. The Stanford method splits aortic dissections into type A and B, with type A dissections involving the ascending aorta. De Bakey classifies dissections into I, II or III depending on their origin and involvement and degree of extension. The key to diagnosis is early suspicion, appropriate imaging and rapid initiation of treatment. Treatment focuses on initial resuscitation, transfer (if possible and required) to a suitable specialist centre, strict blood pressure and heart rate control and potentially surgical intervention depending on the type and complexity of the dissection. Effective post-operative care is extremely important, with awareness of potential post-operative complications and a multi-disciplinary rehabilitation approach required. In this review article we will discuss the aetiology and classifications of aortic dissection, their diagnosis and treatment principles relevant to critical care. Critical care clinicians play a key part in all these steps, from diagnosis through to post-operative care, and thus a thorough understanding is vital.
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Affiliation(s)
- Luke Flower
- Central London School of Anaesthesia, London, UK
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joseph E Arrowsmith
- Department of Anaesthesia, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Association for Cardiothoracic Anaesthesia and Critical Care, UK
| | - Jeremy Bewley
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Samantha Cook
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Graham Cooper
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jake Flower
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Renata Greco
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Syed Sadeque
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Pradeep R Madhivathanan
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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4
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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: 0] [Impact Index Per Article: 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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Liu HY, Zhang SP, Zhang CX, Gao QY, Liu YY, Ge SL. Postoperative hypoxemia for patients undergoing Stanford type A aortic dissection. World J Clin Cases 2023; 11:3140-3147. [PMID: 37274044 PMCID: PMC10237117 DOI: 10.12998/wjcc.v11.i14.3140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/06/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Clinically, it is widely recognized that surgical treatment is the preferred and reliable option for Stanford type A aortic dissection. Stanford type A aortic dissection is an emergent and serious cardiovascular disease characterized with an acute onset, poor prognosis, and high mortality. However, the incidences of postoperative complications are relatively higher due to the complexity of the disease and its intricate procedure. It has been considered that hypoxemia, one of the most common postoperative complications, plays an important role in having a worse clinical prognosis. Therefore, the effective intervention of postoperative hypoxemia is significant for the improved prognosis of patients with Stanford type A aortic dissection.
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Affiliation(s)
- Hai-Yuan Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Shuai-Peng Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Cheng-Xin Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Qing-Yun Gao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Yu-Yong Liu
- First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Sheng-Lin Ge
- First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230032, Anhui Province, China
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6
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Feng D, Huang S, Wang Q, Lang X, Liu Y, Zhang K. Hotspots and development frontiers of postoperative complications of AD: Bibliometric analysis - a review. Medicine (Baltimore) 2023; 102:e33160. [PMID: 36897695 PMCID: PMC9997838 DOI: 10.1097/md.0000000000033160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/13/2022] [Indexed: 03/11/2023] Open
Abstract
The research on the postoperative complications of aortic dissection (AD) has received great attention from scholars all over the world, and the number of research articles in this field has consistently increased year after year. However, no bibliometric reports have been published yet to analyze the scientific output and the current situation in this field. The Bibliometrix R-package, VOSviewer, and CiteSpace software were used to conduct a bibliometric analysis of the hotspots and development frontiers of AD. A total of 1242 articles were retrieved. The USA, China, and Japan had the highest number of publications. The five keywords with the highest frequency were "analysis," "incidence," "acute type," "graft," and "risk factor." The results also indicated that the research in related fields had shifted from surgical treatment and utilizing experience to the evidence-based exploration of risk factors and the construction of prediction models to help better manage postoperative complications of AD. This is the first bibliometric analysis of global publications on the postoperative complications of AD. The current research hotspots focus on three areas: common postoperative complications of AD, exploration of the related risk factors, and management of complications. Future research could focus on identifying risk factors through meta-analysis and using a multicenter database for AD as well as building relevant models to predict the development of complications to better facilitate the clinical management of AD patients.
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Affiliation(s)
- Danni Feng
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sufang Huang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaorong Lang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchen Liu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kexin Zhang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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7
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Latha K, Rao S, Sakamoto K, Watford WT. Tumor Progression Locus 2 Protects against Acute Respiratory Distress Syndrome in Influenza A Virus-Infected Mice. Microbiol Spectr 2022; 10:e0113622. [PMID: 35980186 PMCID: PMC9604045 DOI: 10.1128/spectrum.01136-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/16/2022] [Indexed: 12/30/2022] Open
Abstract
Excessive inflammation in patients with severe influenza disease may lead to acute lung injury that results in acute respiratory distress syndrome (ARDS). ARDS is associated with alveolar damage and pulmonary edema that severely impair gas exchange, leading to hypoxia. With no existing FDA-approved treatment for ARDS, it is important to understand the factors that lead to virus-induced ARDS development to improve prevention, diagnosis, and treatment. We have previously shown that mice deficient in the serine-threonine mitogen-activated protein kinase, Tpl2 (MAP3K8 or COT), succumb to infection with a typically low-pathogenicity strain of influenza A virus (IAV; HKX31, H3N2 [x31]). The goal of the current study was to evaluate influenza A virus-infected Tpl2-/- mice clinically and histopathologically to gain insight into the disease mechanism. We hypothesized that Tpl2-/- mice succumb to IAV infection due to development of ARDS-like disease and pulmonary dysfunction. We observed prominent signs of alveolar septal necrosis, hyaline membranes, pleuritis, edema, and higher lactate dehydrogenase (LDH) levels in the lungs of IAV-infected Tpl2-/- mice compared to wild-type (WT) mice from 7 to 9 days postinfection (dpi). Notably, WT mice showed signs of regenerating epithelium, indicative of repair and recovery, that were reduced in Tpl2-/- mice. Furthermore, biomarkers associated with human ARDS cases were upregulated in Tpl2-/- mice at 7 dpi, demonstrating an ARDS-like phenotype in Tpl2-/- mice in response to IAV infection. IMPORTANCE This study demonstrates the protective role of the serine-threonine mitogen-activated protein kinase, Tpl2, in influenza virus pathogenesis and reveals that host Tpl2 deficiency is sufficient to convert a low-pathogenicity influenza A virus infection into severe influenza disease that resembles ARDS, both histopathologically and transcriptionally. The IAV-infected Tpl2-/- mouse thereby represents a novel murine model for studying ARDS-like disease that could improve our understanding of this aggressive disease and assist in the design of better diagnostics and treatments.
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Affiliation(s)
- Krishna Latha
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - Sanjana Rao
- Department of Genetics, University of Georgia, Athens, Georgia, USA
| | - Kaori Sakamoto
- Department of Pathology, University of Georgia, Athens, Georgia, USA
| | - Wendy T. Watford
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
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Hemli JM, Ducca EL, Chaplin WF, Arader LL, Scheinerman SJ, Lesser ML, Ahn S, Mihelis EA, Jahn LA, Patel NC, Brinster DR. Transfusion in Root Replacement for Aortic Dissection: STS Adult Cardiac Surgery Database Analysis. Ann Thorac Surg 2022; 114:2149-2156. [PMID: 35452664 DOI: 10.1016/j.athoracsur.2022.03.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Transfusion in acute aortic syndromes has been studied in a limited fashion. We sought to describe contemporary transfusion practice for root replacement in acute (Stanford) type A aortic dissection (ATAAD). METHODS The STS Adult Cardiac Surgery Database was interrogated to identify patients who underwent primary aortic root replacement for ATAAD (July 2014 - June 2017). Patients (n = 1558) were stratified by type of root replacement. Multivariate regression was used to determine those variables associated with transfusion and postoperative morbidity. RESULTS Transfusion was required in 90.5% of cases (n = 1410). Operative mortality for all patients was 17.3% (261 deaths). Intraoperative red blood cell (RBC) transfusion portended reduced short-term survival (odds ratio {OR} 2.00, p = 0.025). Massive postoperative transfusion was associated with prolonged ventilation (OR 13.47, p < 0.001), sepsis (OR 4.13, p < 0.001), and new dialysis-dependent renal-failure (OR 2.43, p < 0.001). Females were more likely to require transfusion (OR 3.03, p < 0.001), as were patients who had coronary bypass (OR 1.57, p = 0.009), and those in shock (OR 2.27, p < 0.001). Valve-sparing aortic root replacement (VSARR) was associated with reduced transfusion requirements vs. composite roots. Institutional case volume was not appreciably correlated with transfusion. CONCLUSIONS Most patients undergoing root replacement for aortic dissection require blood products. Composite root replacement is associated with a greater likelihood of transfusion than a valve-sparing operation. Transfusion independently foreshadows greater operative mortality.
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Affiliation(s)
- Jonathan M Hemli
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA.
| | - Emma L Ducca
- Department of Psychology, St John's University, Queens, NY, USA
| | | | | | - S Jacob Scheinerman
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
| | - Martin L Lesser
- Biostatistics Unit, Feinstein Institutes for Medical Research / Northwell Health, Great Neck, NY, USA
| | - Seungjun Ahn
- Biostatistics Unit, Feinstein Institutes for Medical Research / Northwell Health, Great Neck, NY, USA
| | - Efstathia A Mihelis
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
| | - Lynda A Jahn
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
| | - Nirav C Patel
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
| | - Derek R Brinster
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
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9
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Sanfilippo F, Palumbo GJ, Bignami E, Pavesi M, Ranucci M, Scolletta S, Pelosi P, Astuto M. Acute Respiratory Distress Syndrome in the Perioperative Period of Cardiac Surgery: Predictors, Diagnosis, Prognosis, Management Options, and Future Directions. J Cardiothorac Vasc Anesth 2022; 36:1169-1179. [PMID: 34030957 PMCID: PMC8141368 DOI: 10.1053/j.jvca.2021.04.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 12/13/2022]
Abstract
Acute respiratory distress syndrome (ARDS) after cardiac surgery is reported with a widely variable incidence (from 0.4%-8.1%). Cardiac surgery patients usually are affected by several comorbidities, and the development of ARDS significantly affects their prognosis. Herein, evidence regarding the current knowledge in the field of ARDS in cardiac surgery is summarized and is followed by a discussion on therapeutic strategies, with consideration of the peculiar aspects of ARDS after cardiac surgery. Prevention of lung injury during and after cardiac surgery remains pivotal. Blood product transfusions should be limited to minimize the risk, among others, of lung injury. Open lung ventilation strategy (ventilation during cardiopulmonary bypass, recruitment maneuvers, and the use of moderate positive end-expiratory pressure) has not shown clear benefits on clinical outcomes. Clinicians in the intraoperative and postoperative ventilatory settings carefully should consider the effect of mechanical ventilation on cardiac function (in particular the right ventricle). Driving pressure should be kept as low as possible, with low tidal volumes (on predicted body weight) and optimal positive end-expiratory pressure. Regarding the therapeutic options, management of ARDS after cardiac surgery challenges the common approach. For instance, prone positioning may not be easily applicable after cardiac surgery. In patients who develop ARDS after cardiac surgery, extracorporeal techniques may be a valid choice in experienced hands. The use of neuromuscular blockade and inhaled nitric oxide can be considered on a case-by-case basis, whereas the use of aggressive lung recruitment and oscillatory ventilation should be discouraged.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy.
| | | | - Elena Bignami
- Unit of Anesthesiology, Division of Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Pavesi
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Sabino Scolletta
- Department of Urgency and Emergency, of Organ Transplantation, Anesthesia and Intensive Care, Siena University Hospital, Siena, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. “Policlinico-San Marco”, Catania, Italy,Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
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10
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Wang Q, Feng W, Kuang J, Wu J, Yang J, Li C, Fan R. Prediction model for postoperative severe acute lung injury in patients undergoing acute type A aortic dissection surgery. J Card Surg 2022; 37:1602-1610. [PMID: 35348246 DOI: 10.1111/jocs.16447] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to establish a risk assessment model to predict postoperative severe acute lung injury (ALI) risk in patients with acute type A aortic dissection (ATAAD). METHODS Consecutive patients with ATAAD admitted to our hospital were included in this retrospective assessment and placed in the postoperative severe ALI and nonsevere ALI groups based on the presence or absence of ALI within 72 h postoperatively (oxygen index [OI] ≤ 100 mmHg). Patients were then randomly divided into training and validation groups in a ratio of 8:2. Univariate and multivariate stepwise forward logistic regression analyses were used to statistically assess data and establish the prediction model. The prediction model's effectiveness was evaluated via 10-fold cross-validation of the validation group to facilitate the construction of a nomogram. RESULTS After the screening, 479 patients were included in the study: 132 (27.6%) in the postoperative severe ALI group and 347 (72.4%) in the postoperative nonsevere ALI group. Based on multivariate logistics regression analyses, the following variables were included in the model: coronary heart disease, cardiopulmonary bypass (CPB) ≥ 257.5 min, left atrium diameter ≥ 35.5 mm, hemoglobin ≤ 139.5 g/L, preCPB OI ≤ 100 mmHg, intensive care unit OI ≤ 100 mmHg, left ventricular posterior wall thickness ≥ 10.5 mm, and neutrophilic granulocyte percentage ≥ 0.824. The area under the receiver operating characteristic (ROC) curve of the modeling group was 0.805 and differences between observed and predicted values were not deemed statistically significant via the Hosmer-Lemeshow test (χ2 = 6.037, df = 8, p = .643). For the validation group, the area under the ROC curve was 0.778, and observed and predicted value differences were insignificant when assessed using the Hosmer-Lemeshow test (χ2 = 3.3782, df = 7; p = .848). The average 10-fold cross-validation score was 0.756. CONCLUSIONS This study established a prediction model and developed a nomogram to determine the risk of postoperative severe ALI after ATAAD. Variables used in the model were easy to obtain clinically and the effectiveness of the model was good.
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Affiliation(s)
- Qiuji Wang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of clinical medicine, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Weiqi Feng
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of clinical medicine, School of Medicine, South China University of Technology, Guangzhou, China
| | - Juntao Kuang
- Department of Cardiovascular Surgery, Guangzhou First People's Hospital, Guangzhou, China
| | - Jinlin Wu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jue Yang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chenxi Li
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruixin Fan
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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11
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Wang W, Satti DI, Harky A, Mayhew D. Clinical assessment or scoring model for acute lung injury: A crossing path? J Card Surg 2022; 37:1611-1612. [PMID: 35338717 DOI: 10.1111/jocs.16444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- William Wang
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Danish Iltaf Satti
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - David Mayhew
- Department of Anaesthesia and Critical Care, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK
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12
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Cheng YT, Lee KT, Chang CH, Wu VCC, Chan YS, Chen DY, Chu PH, Chou AH, Liu KS, Chen SW. Effects of dexmedetomidine on surgery for type A acute aortic dissection outcome. Sci Rep 2022; 12:2761. [PMID: 35177747 PMCID: PMC8854389 DOI: 10.1038/s41598-022-06710-w] [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: 08/02/2021] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
No study has evaluated the effect of dexmedetomidine in patients who received surgery for type A aortic dissection. This is the first study to evaluate the effect of dexmedetomidine in aortic dissection patients. This study was executed using data from the Chang Gung Research Database in Taiwan. The CGRD contains the multi‐institutional standardized electronic medical records from seven Chang Gung Memorial hospitals, the largest medical system in Taiwan. We retrospectively evaluate patients who received surgery for acute type A aortic dissection between January 2014 and December 2018. Overall, 511 patients were included, of whom 104 has received dexmedetomidine infusion in the postoperative period. One-to-two propensity score-matching yielded 86 cases in the dexmedetomidine group and 158 cases in the non-dexmedetomidine group. The in-hospital mortality and composite outcome including all-cause mortality, acute kidney injury, delirium, postoperative atrial fibrillation, and respiratory failure, were considered primary outcomes. The in-hospital mortality and composite outcome were similar between groups. The risk of Acute Kidney Injury Network stage 3 acute kidney injury was significantly lower in the dexmedetomidine group than in the non-dexmedetomidine group (8.1% vs 19.0%; OR, 0.38; 95% CI, 0.17–0.86; p = 0.020. The risk of newly-onset dialysis was also significantly lower in the dexmedetomidine group than in the non-dexmedetomidine group (4.7% vs 13.3%; OR, 0.32; 95% CI, 0.11–0.90; p = 0.031). Post-operative dexmedetomidine infusion significantly reduced the rate of severe acute kidney injury and newly-onset dialysis in patients who received surgery for acute type A aortic dissection.
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Affiliation(s)
- Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Kuang-Tso Lee
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan District, Chang Gung University, No. 5 Fuxing Street, Taoyuan City, 33305, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan District, Chang Gung University, No. 5 Fuxing Street, Taoyuan City, 33305, Taiwan
| | - Yi-Shin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan District, Chang Gung University, No. 5 Fuxing Street, Taoyuan City, 33305, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan District, Chang Gung University, No. 5 Fuxing Street, Taoyuan City, 33305, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan District, Chang Gung University, No. 5 Fuxing Street, Taoyuan City, 33305, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Sheng Liu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan. .,Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan District, Chang Gung University, No. 5 Fuxing Street, Taoyuan City, 33305, Taiwan. .,Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
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13
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Duan L, Hu GH, Wang E, Zhang CL, Huang LJ, Duan YY. Del Nido versus HTK cardioplegia for myocardial protection during adult complex valve surgery: a retrospective study. BMC Cardiovasc Disord 2021; 21:604. [PMID: 34922443 PMCID: PMC8683821 DOI: 10.1186/s12872-021-02411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Histidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are intracellular-type and extracellular-type solution respectively, both can provide a long period of myocardial protection with single-dose infusion, but studies comparing the two are rare for adult cardiac surgery. This study aims to evaluate whether DN is suitable for cardioplegia in complex and high-risk valve surgery with long-term cardiac ischemia when compared with HTK. METHODS The perioperative records of adult patients infused with DN/HTK as a cardioplegic solution who underwent complex valve surgery with an expected myocardial ischaemic duration longer than 90 min between Oct 2018 and Oct 2019 were analysed retrospectively. RESULTS Of the 160 patients who received DN/HTK and underwent complex valve surgery, we propensity matched 73 pairs. Both groups achieved satisfactory cardiac arrest effects, and no significant difference was found in their cTnI and CK-MB levels within 12 to 72 h postoperatively. The DN group had a higher rate of return to spontaneous rhythm (0.88 v 0.52, P < 0.001), a lower frequency of postoperative severe arrythmias (12% v 26%, P = 0.036), a higher postoperative stroke volume (65 v 59 ml, P = 0.011) and a higher cardiac output (6.0 v 4.9 L/min, P = 0.007) as evaluated by echocardiography, fewer transfusions and shorter ICU stays (both P < 0.05). The two groups had similar inotrope usage and similar incidences of low cardiac output, morbidities and mortality. Subgroup analysis showed that when the aortic clamping time was greater than 120 min, the advantages of DN were weakened. CONCLUSIONS DN can be safely applied to complex valve surgery, and it has a similar myocardial protection effect as HTK. Further prospective studies are required to verify these retrospective findings. Trial registration retrospectively registered.
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Affiliation(s)
- Lian Duan
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Guo-Huang Hu
- Department of Surgery, Affiliated Changsha Hospital of Hunan Normal University, Changsha, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.
| | - Cheng-Liang Zhang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ling-Jin Huang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yan-Ying Duan
- Department of Occupational and Environmental Health, Public Health School, Central South University, Changsha, China
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14
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Zhao Y, Yue Y, Wang Y, Zhao W, Feng G. The risk factors for postoperative acute respiratory distress syndrome in Stanford type a acute aortic dissection patients. Am J Transl Res 2021; 13:7318-7326. [PMID: 34306500 PMCID: PMC8290718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the risk factors for postoperative acute respiratory distress syndrome (ARDS) in Stanford type A acute aortic dissection (AAD) patients. METHODS This study included 64 patients with Stanford type A AAD who underwent Sun's procedure. The patients were divided into an ARDS group (PaO2/FiO2 < 200 mmHg) and a non-ARDS group (PaO2/FiO2 ≥ 200 mmHg). We compared the patients' perioperative clinical features in the two groups. A multivariate binary logistic regression was used to analyze the risk factors for ARDS in the Stanford type A AAD patients. RESULTS The incidence of postoperative ARDS was 56.25%. There were 13 deaths in the 6-month follow-up, including 8 in the ARDS group and 5 in the non-ARDS group. There were differences in the body mass index (BMI) levels, the times from onset to operation, the preoperative white blood cell counts, the preoperative hemoglobin levels, the preoperative alanine aminotransferase levels, the preoperative blood creatinine levels, the preoperative PaO2/FiO2, intraoperative blood transfusion volumes, the assisted mechanical ventilation times, and the durations of the intensive care unit stays between the two groups (all P < 0.05). The logistic regression analysis revealed that a BMI ≥ 25 kg/m2, a time from onset to operation ≥ 24 hours, a preoperative white blood cell count ≥ 10×109/L, and a preoperative PaO2/FiO2 < 300 mmHg were the independent risk factors for postoperative ARDS in patients with Stanford type A AAD. CONCLUSIONS ARDS occurs often in Stanford type A AAD patients. A BMI ≥ 25 kg/m2, a time from onset to operation ≥ 24 hours, a preoperative white blood cell count ≥ 10×109/L, and a preoperative PaO2/FiO2 < 300 mmHg are the independent risk factors for postoperative ARDS in these patients.
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Affiliation(s)
- Yongbo Zhao
- Department of Cardiovascular Surgery, Fourth Hospital of Hebei Medical UniversityShijiazhuang, Hebei Province, China
| | - Yuehong Yue
- Department of Neurology, Hebei General HospitalShijiazhuang, Hebei Province, China
| | - Yanzhi Wang
- Department of Cardiac Surgery, Hebei General HospitalShijiazhuang, Hebei Province, China
| | - Weichao Zhao
- Department of Cardiovascular Surgery, Fourth Hospital of Hebei Medical UniversityShijiazhuang, Hebei Province, China
| | - Guangxing Feng
- Department of Cardiovascular Surgery, Fourth Hospital of Hebei Medical UniversityShijiazhuang, Hebei Province, China
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15
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Chen J, Chang C, Wu VC, Chang S, Hung K, Chu P, Chen S. Long-Term Outcomes of Acute Kidney Injury After Different Types of Cardiac Surgeries: A Population-Based Study. J Am Heart Assoc 2021; 10:e019718. [PMID: 33880935 PMCID: PMC8200754 DOI: 10.1161/jaha.120.019718] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Dialysis‐requiring acute kidney injury (D‐AKI) is a major complication of cardiovascular surgery that results in worse prognosis. However, the incidence and impacts of D‐AKI in different types of cardiac surgeries have not been fully investigated. Methods and Results Patients admitted for cardiovascular surgery between July 1, 2004, and December 31, 2013, were identified from the National Health Insurance Research Database of Taiwan. The patients were grouped into D‐AKI (n=3089) and non–D‐AKI (n=42 151) groups. The outcome was all‐cause mortality and major adverse kidney event. The long‐term outcomes were worse in the D‐AKI group than the non–D‐AKI group (hazard ratio [HR], 3.89; 95% CI, 3.79–3.99 for major adverse kidney event; HR, 2.89; 95% CI, 2.81–2.98 for all‐cause mortality). Patients who underwent aortic surgery had higher risk for D‐AKI than other types of surgeries, but they were also more likely to recover. The long‐term dialysis rate for the patients who recovered from D‐AKI was also lowest in those who underwent aortic surgery. Among all types of cardiac surgeries with D‐AKI, patients who had heart valve surgery exhibited the greatest risks of all‐cause mortality (HR, 6.04; 95% CI, 5.78–6.32). Conclusions Compared with other heart surgeries, aortic surgery resulted in a higher incidence of D‐AKI but better renal recovery, better short‐term outcome, and lower incidences of long‐term dialysis.
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Affiliation(s)
- Jia‐Jin Chen
- Department of NephrologyChang Gung Memorial Hospital, Linkou Medical centerTaoyuanTaiwan
| | - Chih‐Hsiang Chang
- Department of NephrologyChang Gung Memorial Hospital, Linkou Medical centerTaoyuanTaiwan
- Department of NephrologyKidney Research CenterChang Gung Memorial HospitalTaoyuan CityTaiwan
| | - Victor Chien‐Chia Wu
- Department of CardiologyChang Gung Memorial HospitalLinkou Medical CenterTaoyuan CityTaiwan
| | - Shang‐Hung Chang
- Department of CardiologyChang Gung Memorial HospitalLinkou Medical CenterTaoyuan CityTaiwan
| | - Kuo‐Chun Hung
- Department of CardiologyChang Gung Memorial HospitalLinkou Medical CenterTaoyuan CityTaiwan
| | - Pao‐Hsien Chu
- Department of CardiologyChang Gung Memorial HospitalLinkou Medical CenterTaoyuan CityTaiwan
| | - Shao‐Wei Chen
- Division of Thoracic and Cardiovascular SurgeryDepartment of SurgeryChang Gung Memorial HospitalLinkou Medical CenterChang Gung UniversityTaoyuan CityTaiwan
- Center for Big Data Analytics and StatisticsChang Gung Memorial HospitalLinkou Medical CenterTaoyuan CityTaiwan
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16
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Hsu ME, Cheng YT, Chang CH, Chan Y, Wu VCC, Hung KC, Lin CP, Liu KS, Chu PH, Chen SW. Level of serum soluble lumican and risks of perioperative complications in patients receiving aortic surgery. PLoS One 2021; 16:e0247340. [PMID: 33661915 PMCID: PMC7932520 DOI: 10.1371/journal.pone.0247340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Several serum biomarkers have been investigated for their potential as diagnostic tools in aortic disease; however, no study has investigated the association between serum biomarkers and outcomes after aortic surgery. This study explored the predictive ability of serum soluble lumican in postoperative outcomes after aortic surgery. Methods In total, 58 patients receiving aortic surgery for aortic dissection or aneurysm at Linkou Chang Gung Memorial Hospital in Taiwan in December 2011–September 2018 were enrolled. Blood samples were collected immediately upon patients’ arrival in the intensive care unit after aortic surgery. The diagnostic properties of soluble lumican levels were assessed by performing receiver operating characteristic (ROC) curve analysis. The confidence interval (CI) of the area under the ROC curve (AUC) was measured using DeLong’s nonparametric method and the optimal cutoff was determined using the Youden index. Results The serum soluble lumican level distinguished prolonged ventilation (AUC, 73.5%; 95% CI, 57.7%–89.3%) and hospital stay for >30 days (AUC, 78.2%; 95% CI, 61.6%–94.7%). The optimal cutoffs of prolonged ventilation and hospital stay for >30 days were 1.547 and 5.992 ng/mL, respectively. The sensitivity and specificity were respectively 100% (95% CI, 71.5%–100%) and 40.4% (95% CI, 26.4%–55.7%) for prolonged ventilation and 58% (95% 27.7%–84.8%) and 91.3% (95% CI, 79.2%–97.6%) for hospital stay for >30 days. Conclusions The serum soluble lumican level can be a potential prognostic factor for predicting poor postoperative outcomes after aortic surgery. However, more studies are warranted in the future.
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Affiliation(s)
- Ming-En Hsu
- Department of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Division of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - Yi‐Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Chun Hung
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Chia-Pin Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Sheng Liu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
- * E-mail: (SWC); (PHC)
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- * E-mail: (SWC); (PHC)
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