Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection

Chen, Mei‐Fang; Cao, Hua; Lin, Yu

doi:10.21037/jtd.2016.10.10

Cited by 22 publications

(21 citation statements)

References 24 publications

(15 reference statements)

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“…On the other hand, the system inflammatory response that attacked the lungs increased the risk of respiratory infection. Respiratory complications were important causes of surgical mortality for TAAD [21]. In our own data, prolonged mechanical ventilation assistance time after surgery was also associated with elevated preoperative WBCc.…”

Section: Discussionmentioning

confidence: 54%

The elevated admission white blood cell count relates to adverse surgical outcome of acute Stanford type a aortic dissection

Shi

Xiao

et al. 2020

J Cardiothorac Surg

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Background: The purpose of the study was to examine the association between white blood cell count (WBCc) on admission and early outcome in patients with the acute Stanford type A aortic dissection (TAAD). Methods: From January 2012 to December 2018, we retrospectively evaluated a series of 331 consecutive patients underwent surgery for TAAD in Tongji Hospital. The patients were divided into 2 groups based on the WBCc, i.e. the normal WBCc group (WBCc≤11 × 10 9 /L) and leukocytosis group (WBCc> 11 × 10 9 /L). The perioperative data were compared between the 2 groups. The in-hospital mortality and the compositive adverse event including multi-organ dysfunction syndrome, postoperative stroke, tracheotomy, and re-exploration for stopping bleeding were set as end points. Cox regression were used to assess the potential risk factors. Results: The in-hospital mortality was nearly 3 time higher in the leukocytosis group than in the normal WBCc group (20.9% vs.8.1%, P = 0.001), and 15.1% overall. For the circulatory arrest, there was significant higher mortality in patients with leukocytosis than normal WBCc group (26.1%vs.8.9%, P = 0.001). After adjustment for confounding factors, the leukocytosis was found to be a strong independent predictor of in-hospital mortality (odds ratio = 3.10; 95% confidence interval 1.38 to 6.97, P = 0.006). The leukocytosis was also a risk factor of adverse events (odds ratio = 1.80; 95% confidence interval 1.07 to 3.04, P = 0.027). Conclusions: The WBCc within 24 h of admission for TAAD is a strong and independent predictor of in-hospital mortality as well as short-term clinical events. The results of this study have important clinical implications for riskstratifying patients with TAAD.

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Section: Discussionmentioning

confidence: 54%

The elevated admission white blood cell count relates to adverse surgical outcome of acute Stanford type a aortic dissection

Shi

Xiao

et al. 2020

J Cardiothorac Surg

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“…[20] Chen et al's study involving 527 patients who had undergonetype A dissection repair surgery showed that perioperative transfusion volume was an independent risk factor for postoperative ARDS. [21] A targeted preventative strategy may decrease the development of ARDS, if risk factors can be identified early. Meticulous hemostasis and improvement of surgical technique for decreasing perioperative blood product transfusion may reduce the incidence of postoperative ARDS and improve postoperative outcomes in this population.…”

Section: Discussionmentioning

confidence: 99%

Risk factor analysis of postoperative acute respiratory distress syndrome after type A aortic dissection repair surgery

Su¹,

Wu²,

Chou

et al. 2019

Medicine

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To investigate the incidence, outcomes, and risk factors of postoperative acute respiratory distress syndrome (ARDS) in patients undergoing surgical repair for acute type A aortic dissection. This retrospective study involved 270 patients who underwent surgical repair for acute type A aortic dissection between January 2009 and December 2015. Data on clinical characteristics and outcomes were collected. Patients who immediately died after surgery and with preoperative myocardial dysfunction were excluded. The included patients were divided into the ARDS (ARDS patients who met the Berlin definition) and non-ARDS groups. Primary outcome was postoperative ARDS, according to the 2012 Berlin definition for ARDS and was reviewed by 2 qualified physicians with expertise in critical care and cardiac surgery. Outcomes of interest were the incidence and severity of risk factors for ARDS in this population, and perioperative outcomes and survival rates were compared with patients with or without ARDS. A total of 233 adult patients were enrolled into this study; of these, 37 patients (15.9%) had ARDS. Three, 20, and 14 patients had mild, moderate, and severe ARDS, respectively, according to the Berlin definition, with no significant difference in age, sex, and underlying disease. The ARDS group had lower mean oxygenation index (OI) than the non-ARDS group in the first 3 days post-surgery and demonstrated an improvement in lung function after the fourth day. Postoperative complication risks were higher in the ARDS group than in the non-ARDS group. However, no significant difference was observed in in-hospital mortality between the 2 groups (10.8% vs 5.6%, P = .268). Additionally, there was also no significant difference in the 3-year mortality rate between the 2 groups ( P of log-rank test = .274). Postoperative hemoglobin level (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.62–0.99) and perioperative blood transfusion volume (OR: 1.07; 95% CI: 1.03–1.12) were associated with ARDS risk. Postoperative ARDS after type A aortic dissection repair surgery was associated with risks of postoperative complications but not with risk of in-hospital mortality or 3-year mortality. A higher perioperative blood transfusion volume and a lower postoperative hemoglobin level may be risk factors for ARDS.

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“…Sheng et al (7) also suggested that a preoperative PaO 2 /FiO 2 ≤300 mmHg was an independent risk factor of hypoxemia after surgery for Stanford type-A AAD. Increased postoperative oxygenation impairment may occur due to an increased inflammatory response that is associated with the magnitude of the operative injury and the procedure (24)(25)(26)(27)(28). Therefore, taking measures to improve ALI earlier is crucial for the prognosis of Stanford type-A AAD patients.…”

Section: Discussionmentioning

confidence: 99%

Oxygenation impairment in patients with acute aortic dissection is associated with disorders of coagulation and fibrinolysis: a prospective observational study

Gao¹,

Pei²,

He³

et al. 2019

J. Thorac. Dis

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Background: Stanford type-A acute aortic dissection (AAD) is typically accompanied by oxygenation impairment before surgery. In addition, inflammation, coagulation and fibrinolysis also impair blood oxygenation. However, our understanding of the concentration of these factors in bronchoalveolar lavage fluid (BALF) has not been reported. The objective of the study was to investigate the impact of preoperative acute lung injury (ALI) on postoperative oxygenation impairment and to explore the effect of coagulation and fibrinolysis in blood and BALF. Methods: This investigation utilized a prospective observational study design, which was registered at www. clinicaltrials.gov (identifier NCT01894334). The study included 53 patients undergoing surgery for Stanford type-A AAD at an academic hospital in China between October 2013 and July 2014. Preoperative ALI was identified according to the oxygenation index calculated by the PaO 2 /FiO 2 ratio. The subjects were divided into the ALI group (oxygenation index ≤300 mmHg) or the control group (oxygenation index >300 mmHg). The primary outcome was patient oxygenation index, while secondary outcomes were concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI), and plasminogen activator inhibitor-1 (PAI-1) in serum and BALF. Results: The incidence of preoperative ALI for Stanford type-A AAD patients was 41.5%. Stanford type-A AAD patients with preoperative ALI had a lower postoperative oxygenation index (104.6±31.7 vs. 248.7± 48.0 mmHg, P<0.001), higher concentrations of TF in serum and BALF (F=133.67, P<0.001; F=68.14, P<0.001), higher concentrations of TFPI in serum and BALF (F=31.98, P<0.001; F=45.58, P<0.001), and higher concentrations of PAI-1 in serum and BALF (F=213.88, P<0.001; F=107.95, P<0.001) when compared with those without preoperative ALI. Type-A AAD patients also showed a greater loss of blood (1,524±458 vs. 1,175±327 mL, P=0.040), longer mechanical ventilation time in the ICU (27.24±8.37 vs. 17.33±7.36 h, P<0.001), longer total stay in the ICU (42.27±10.85 vs. 33.45±9.05 h, P=0.002), and longer total hospital stay (17.77±5.00 vs. 13.48±3.97 days, P=0.001). Multivariate linear regression analysis indicated that preoperative PAI-1 in BALF, and TF in both serum and BALF were significantly associated with preoperative oxygenation impairment in patients with Stanford type-A AAD. Conclusions: Preoperative ALI caused more serious postoperative oxygenation impairment for Stanford type-A AAD, and coagulation and fibrinolysis appear to play critical roles in this process. Preoperative PAI-1 in BALF and TF in both serum and BALF were significant factors related to the occurrence of preoperative oxygenation impairment for Stanford type-A AAD.

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Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection

Cited by 22 publications

References 24 publications

The elevated admission white blood cell count relates to adverse surgical outcome of acute Stanford type a aortic dissection

The elevated admission white blood cell count relates to adverse surgical outcome of acute Stanford type a aortic dissection

Risk factor analysis of postoperative acute respiratory distress syndrome after type A aortic dissection repair surgery

Oxygenation impairment in patients with acute aortic dissection is associated with disorders of coagulation and fibrinolysis: a prospective observational study

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