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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: 0] [Impact Index Per Article: 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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Guan X, Li L, Lu X, Gong M, Li H, Liu Y, Jiang W, Lan F, Wang X, Zhang H. Safety and efficacy of fibrinogen concentrate in aortic arch surgery involving moderate hypothermic circulatory arrest. J Thromb Thrombolysis 2023; 55:67-73. [PMID: 36169914 DOI: 10.1007/s11239-022-02706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Bleeding is a common complication of cardiac surgery, especially aortic arch surgery involving moderate hypothermic circulatory arrest. Fibrinogen concentrate has been increasingly used to treat coagulopathic bleeding in cardiac surgery, although its effectiveness and safety are unknown. The aim of this prospective study was to investigate the safety and efficacy of fibrinogen concentrate in patients with acute type A aortic dissection. METHODS From July 2020 to August 2021, 84 patients with acute type A aortic dissection who underwent emergency aortic arch surgery involving MHCA and whose intraoperative fibrinogen level was less than 1.5 g/L were included in this study. Fifty-four patients who were supplemented with fibrinogen concentrate were included in the FC treatment group. Thirty patients were included in the non-FC treatment group. The primary endpoints included the required volumes of individual allogeneic blood products (RBCs, FFP, and PC), volumes of cumulative drainage within 24 and 48 h, and total volumes after infusion of FC, as well as reoperation rates due to bleeding. The secondary endpoint for the study was the incidence of serious adverse events from the infusion of FC to day 45. The serious adverse events defined for the evaluation of the safety of FC were death, pulmonary embolism and other thromboembolic or ischaemic events. The clinical data, routine laboratory tests and plasma fibrinogen levels were obtained at 5 time points. RESULTS We observed rapid increases in the plasma fibrinogen level and subsequent improvement in haemostasis after the administration of fibrinogen concentrate. The mean fibrinogen level increased from 1.36 ± 0.75 g/L to 2.91 ± 0.76 g/L in the fibrinogen concentrate treatment group. The patients in the fibrinogen concentrate treatment group demonstrated lower volumes of cumulative postoperative drainage and transfused allogeneic blood products than the nonfibrinogen concentrate treatment group. There were no serious adverse events in the fibrinogen concentrate treatment group during hospitalization. CONCLUSION Fibrinogen concentrate was effective at increasing the plasma fibrinogen level and significantly reduced the volumes of transfused allogeneic blood products and blood loss in patients with aortic arch surgery. There were no serious adverse events in the patients who received fibrinogen concentrate treatment. PERSPECTIVE STATE The safety and efficacy of fibrinogen concentrate were investigated in acute type A aortic dissection patients with aortic arch surgery. Fibrinogen concentrate was effective at increasing the plasma fibrinogen level and significantly reduced the volumes of transfused allogeneic blood products and blood loss; there were no serious adverse events in the patients who received fibrinogen concentrate treatment.
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Affiliation(s)
- XinLiang Guan
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China
| | - Lei Li
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China
| | - XuRan Lu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China
| | - Ming Gong
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China
| | - HaiYang Li
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China
| | - YuYong Liu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China
| | - WenJian Jiang
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China
| | - Feng Lan
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China
| | - XiaoLong Wang
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China. .,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China.
| | - HongJia Zhang
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China. .,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China. .,Beijing Engineering Research Center of Vascular Prostheses, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, China.
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Sarafidis P, Martens S, Saratzis A, Kadian-Dodov D, Murray PT, Shanahan CM, Hamdan AD, Engelman DT, Teichgräber U, Herzog CA, Cheung M, Jadoul M, Winkelmayer WC, Reinecke H, Johansen K. Diseases of the Aorta and Kidney Disease: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Cardiovasc Res 2021; 118:2582-2595. [PMID: 34469520 PMCID: PMC9491875 DOI: 10.1093/cvr/cvab287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic kidney disease (CKD) is an independent risk factor for the development of abdominal aortic aneurysm (AAA), as well as for cardiovascular and renal events and all-cause mortality following surgery for AAA or thoracic aortic dissection. In addition, the incidence of acute kidney injury (AKI) after any aortic surgery is particularly high, and this AKI per se is independently associated with future cardiovascular events and mortality. On the other hand, both development of AKI after surgery and the long-term evolution of kidney function differ significantly depending on the type of AAA intervention (open surgery vs. the various subtypes of endovascular repair). Current knowledge regarding AAA in the general population may not be always applicable to CKD patients, as they have a high prevalence of co-morbid conditions and an elevated risk for periprocedural complications. This summary of a Kidney Disease: Improving Global Outcomes Controversies Conference group discussion reviews the epidemiology, pathophysiology, diagnosis, and treatment of Diseases of the Aorta in CKD and identifies knowledge gaps, areas of controversy, and priorities for future research.
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Affiliation(s)
- Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sven Martens
- Department of Cardiothoracic Surgery - Division of Cardiac Surgery, Münster, University Hospital, Universitätsklinikum, Münster, Germany
| | - Athanasios Saratzis
- Department of Vascular Surgery, Leicester University Hospital and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick T Murray
- Department of Nephrology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Catherine M Shanahan
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Allen D Hamdan
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel T Engelman
- Heart, Vascular & Critical Care Services Baystate Medical Center, and University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Ulf Teichgräber
- Department of Radiology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA.,Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | | | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Holger Reinecke
- Department of Cardiology I: Coronary and peripheral vessel disease, heart failure; Münster University Hospital, Universitätsklinikum, Münster, Germany
| | - Kirsten Johansen
- Division of Nephrology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
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