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

Yinghua Wang, Song Xue, Hongsheng Zhu, Yinghua Wang, Song Xue, Hongsheng Zhu

Abstract

Background: The purpose of this study is to identify the risk factors for postoperative hypoxemia in patients with Stanford A aortic dissection surgery and their relation to clinical outcomes.

Methods: Clinical records of 186 patients with postoperative hypoxemia in Stanford A aortic dissection were analyzed retrospectively. The patients were divided into two groups by postoperative oxygen fraction (PaO2/FiO2):hypoxemia group (N=92) and non-hypoxemia group (N=94).

Results: We found that the incidence of postoperative hypoxemia was 49.5%. Statistical analysis by t-test and χ2 indicated that acute onset of the aortic dissection (p=0.000), preoperative oxygen fraction (PaO2/FiO2) ≤200 mmHg(p=0.000), body mass index (p=0.008), circulatory arrest (CA) time (p=0.000) and transfusion more than 3000 ml(p=0.000) were significantly associated with postoperative hypoxemia. Multiple logistic regression analysis showed that preoperative hypoxemia, CA time and transfusion more than 3000 ml were independently associated with postoperative hypoxemia in Stanford A aortic dissection.

Conclusion: Our results suggest that postoperative hypoxemia is a common complication in patients treated by Stanford A aortic dissection surgery. Preoperative oxygen fraction lower than 200 mmHg, longer CA time and transfusion more than 3000 ml are predictors of postoperative hypoxemia in Stanford A aortic dissection.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curve.

References

    1. Takayuki N, Kohei K, Hiroshi I, Tsuyoshi K, Hiroyuki N, Nobuo S. Risk factors for hypoxemia after surgery for acute type A aortic dissection. Surg Today. 2006;36:680–685. doi: 10.1007/s00595-006-3226-5.
    1. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH. Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery. Eur J Cardiothorac Surg. 2008;34(5):953–959. doi: 10.1016/j.ejcts.2008.07.061.
    1. Ji Q, Mei Y, Wang X, Feng J, Cai J, Sun Y, Xie S, Li D, Dayi H. Study on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Circ J. 2008;72:1975–1980. doi: 10.1253/circj.CJ-08-0369.
    1. Yende S, Wunderink R. Causes of prolonged mechanical ventilation after coronary artery bypass surgery. Chest. 2002;122:245–252. doi: 10.1378/chest.122.1.245.
    1. Branca P, McGaw P, Light RW. Factors associated with prolonged mechanical ventilation following coronary artery bypass surgery. Chest. 2001;119:537–546. doi: 10.1378/chest.119.2.537.
    1. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest. 2008;133(3):713–721. doi: 10.1378/chest.07-1028.
    1. Girdauskas E, Kuntze T, Borger MA. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg. 2010;37:691–696. doi: 10.1016/j.ejcts.2009.07.016.
    1. Kurabayashi M, Okishige K, Azegami K. Reduction of the PaO2/FiO2 ratio in acute aortic dissection. Circ J. 2010;74:2066–2073. doi: 10.1253/circj.CJ-10-0336.
    1. Weiss YG, Merlin G, Koganov E, Ribo A, Oppenheim-Eden A, Medalion B. Postcardiopulmonary bypass hypoxemia: a prospective study on incidence, risk factors and clinical significance. J Cardiothorac Vasc Anesth. 2001;14:506–513.
    1. Milot J, Perron J, Lacasse Y, Letourneau L, Cartier PC, Maltais F. Incidence and predictors of ARDS after cardiac surgery. Chest. 2001;119:884–888. doi: 10.1378/chest.119.3.884.
    1. Szeles TF, Yoshinaga EM, Alenca W, Brudniewski M, Ferreira FS, Auler JO, Carmona MJ, Malbouisson LM. Hypoxemia after myocardial revascularization: analysis of risk factors. Rev Bras Anestesil. 2008;58(2):124–136.
    1. Salis S, Mazzanti VV, Merli G, Salvi L, Tedesco CC, Veglia F, Sisillo E. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22(6):814–822. doi: 10.1053/j.jvca.2008.08.004.
    1. Kimura N, Tanaka M, Kawahito K, Sanui M, Yamaguchi A, Ino T, Adachi H. Risk factors for prolonged mechanical ventilation following surgery for acute type A aortic dissection. Circ J. 2008;72:1751–1757. doi: 10.1253/circj.CJ-08-0306.
    1. Ip P, Chiu CS, Cheung Y. Risk factors prolonging ventilation in young children after cardiac surgery: impact of noninfectious pulmonary compolication. Pediatr Crit Care Med. 2002;3:269–274. doi: 10.1097/00130478-200207000-00013.
    1. Garcia Montes JA, Calderon Colmenero J, Casanova M. Risk factors for prolonged mechanical ventilation after surgical repair of congenital heart disease. Arch Cardiol Mex. 2005;75:402–407.
    1. Szekely A, Sapi E, Kiraly L. Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery. Paediatr Anaesth. 2006;16:1166–1175.
    1. Chiappini B, Schepens M, Tan E, Dell Amore A, Morshuis W, Dossche K. Early outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. Eur Heart J. 2004;26:180–186. doi: 10.1093/eurheartj/ehi024.
    1. Sugano Y, Anzai T, Yoshikawa T, Satoh T, Iwanaga S, Hayashi T. Serum C-reactive protein elevation predicts poor clinical outcome in patients with distal type acute aortic dissection: association with the occurrence of oxygenation impairment. Int J Cardiol. 2005;102:39–45. doi: 10.1016/j.ijcard.2004.03.076.
    1. Kallenbach K, Oelze T, Salcher R, Hagl C, Karck M, Leyh RG. Evolving strategies for treatment of acute aortic dissection type A. Circulation. 2004;110(Suppl I):II243–II249.
    1. Shi S, Zao Z, Liu X, Shu Q, Linhua Tan R, Lin ZS, Fang X. Perioperative risk factors for prolonged mechanical ventilation following cardiac surgery in neonates and young infants. Chest. 2008;134:768–774. doi: 10.1378/chest.07-2573.
    1. Cislaghi F, Condemi AM, Corona A. Predictors of prolonged mechanical ventilation in a cohort of 3269 CABG patients. Minerva Anestesiol. 2007;73:615–621.
    1. Kin H, Kawazoe K, Nakajima K, Niinuma T, Kataoka T, Endo S. Perioperative serum procalcitonin concentrations in patients with acute aortic dissection. Eur Surg Res. 2003;35:451–454. doi: 10.1159/000072231.
    1. Hasegawa Y, Ishikawa S, Ohtaki A, Otani Y, Takahashi T, Sato Y. Impaired lung oxygenation in acute aortic dissection. J Cardiovasc Surg (Torino) 1999;40:191–195.
    1. Rothenburger M, Soeparwata R, Deng MC, Schmid C, Berendes E, Tjan TD. Prediction of clinical outcome after cardiac surgery: the role of cytokines, endotoxin and anti-endotoxin core antibodies. Shock. 2001;16(Suppl I):44–50.
    1. Raja SG, Dreyfus GD. Modulation of systemic inflammatory response after cardiac surgery. Asian Cardiovasc Thorac Ann. 2005;13:382–395. doi: 10.1177/021849230501300422.
    1. Baufreton C, Corbeau JJ, Pinaud F. Inflammatory response and haematological disorders in cardiac surgery: toward a more physiological cardiopulmonary bypass. Ann Fr Anesth Reanim. 2006;25:510–520. doi: 10.1016/j.annfar.2005.12.002.
    1. Asimakopoulos G. Systemic inflammation and cardiac surgery an update. Perfusion. 2001;16:353–360. doi: 10.1177/026765910101600505.
    1. De Santo LS, Romano G, Amarelli C. Surgical repair of acute type A aortic dissection: continuous pulmonary perfusion during retrograde cerebral perfusion prevents lung injury in a pilot study. J Thorac Cardiovasc Surg. 2003;126:826–831. doi: 10.1016/S0022-5223(03)00583-X.
    1. Khan H, Belsher J, Yilmaz M, Afessa B, Winters JL, Moore SB, Hubmayr RD, Gajic O. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest. 2007;131(5):1308–1314. doi: 10.1378/chest.06-3048.
    1. Zilberberg MD, Carter C, Lefebvre P, Raut M, Vekeman F, Duh MS, Shorr AF. Red blood cell transfusions and the risk of acute respiratory distress syndrome among the critically ill: a cohort study. Crit Care. 2007;11(3):R63. doi: 10.1186/cc5934.
    1. Székely A, Cserép Z, Sápi E, Breuer T, Nagy CA, Vargha P, Hartyánszky I, Szatmári A, Treszl A. Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations. Ann Thorac Surg. 2009;87(1):187–197. doi: 10.1016/j.athoracsur.2008.09.079.
    1. Lumachi F, Marzano B, Fanti G, Basso SM, Mazza F, Chiara GB. Relationship between body mass index, age and hypoxemia in patients with extremely severe obesity undergoing bariatric surgery. In Vivo. 2010;24(5):775–777.
    1. Gong MN, Thompson BT, Williams P, Pothier L, Boyce PD, Christiani DC. Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion. Crit Care Med. 2005;33(6):1191–1198. doi: 10.1097/01.CCM.0000165566.82925.14.

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