Ascending Aorta and Hemiarch Replacement Combined With Modified Triple-Branched Stent Graft Implantation for Repair of Acute DeBakey Type I Aortic Dissection

Chen, Liangwan; Dai, Xiao-Fu; Wu, Xi-Jie; Liao, Dong-Shan; Hu, Yunnan; Zhang, Hui; Yan, Dong

doi:10.1016/j.athoracsur.2016.06.017

Cited by 51 publications

(62 citation statements)

References 21 publications

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“…Acute lung injury can lead to increased permeability of pulmonary vascular bed, pulmonary interstitial and alveolar edema, alveolar collapse, severe imbalance of ventilation/blood ow ratio, and eventually severe hypoxemia [24] . At the same time, hypoxemia can inhibit the synthesis of acetyl coenzyme A, acetylcholine, and glutamic acid in the citric acid cycle, resulting in decreased brain activity of cholinergic, which ultimately leads to an increased risk of delirium [13] . In addition, studies have shown that hypoxemia and mechanical ventilation time are interrelated.…”

Section: Discussionmentioning

confidence: 99%

“…Their studies found that surgery duration, cardiopulmonary bypass (CPB) time, and selective cerebral perfusion (SCP) time were risk factors for delirium after AD. Although the novel triple-branched stent graft implantation signi cantly shortens the operation time, CPB time and aortic cross-clamping time by reducing vascular anastomosis of the branches of the aortic arch, nervous system complications remain one of the commonest and worst ones [12,13] . The incidence and risk factors of delirium after the novel triple-branched stent graft implantation have not been studied.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

Lin

Chen

Zhang

et al. 2020

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Background: Neurological complications is a common complication following novel triple-branched stent graft implantation in patients with Stanford type A aortic dissection (AAD). But the incidence and risk factors of postoperative delirium (POD) are not completely clear. The aim of this study was to investigate the incidence and risk factors of POD after novel triple-branched stent graft implantation.Methods: An observational study of AAD patients who underwent novel triple-branched stent graft implantation between January 2017 and July 2019 were followed up after surgery. Patients’ delirium was screened by the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the intensive care unit from the first day after the operation, lasted 5 days. The risk factors of POD were analyzed by the Cox proportional hazard models.Results: A total of 280 AAD patients were enrolled in this research, the incidence of POD was 37.86%. Adjusting for age, body mass index, and mechanical ventilation duration, multivariate Cox regression analysis model revealed that non-manual work (adjusted hazard ratio [AHR] = .554; 95% CI: 0.335-0.915; P = .021), Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores > 20 (AHR = 3.359, 95% CI: 1.707-6.609, P < .001), hypoxemia (AHR = 1.846, 95% CI: 1.118-3.048, P = .017), and more than two types of analgesics and sedatives were independently associated with POD.Conclusions: This study showed that risk factors independently associated with POD were APACHE-II score > 20, hypoxemia, and more types of analgesics and sedatives, and non-manual work was the protective factor.Trial registration: This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR1900022408; Date: 2019/4/10)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

Lin

Chen

Zhang

et al. 2020

Preprint

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“…Intermittent cold‐blood cardioplegia was perfused through the left and right coronary arteries for myocardial protection. The following procedures, including the triple‐branched stent graft implantation, can be found in our previous literature …”

Section: Methodsmentioning

confidence: 99%

“…Other methods to prevent cerebral hypoxia included increasing the pump flow, increasing the FiO 2 and performing allogeneic blood transfusion. The patients in group B received conventional brain protection strategy without the guidance of intraoperative rcSO 2 monitoring …”

Section: Methodsmentioning

confidence: 99%

“…Although the duration of a systemic circulatory arrest has been significantly shortened by the novel triple‐branched stent graft implantation and the cerebrovascular perfusion technique has been modified, cerebral dysfunction is still one of the most common and serious complications resulting from Stanford type A aortic dissection (AAD) surgery in our department (with rates of complications ranging from 8.6% to 10.7%) It is currently known that the main mechanism of postoperative cerebral dysfunction is the disbalance of oxygen metabolism in the brains of patients. Compared with conventional monitoring methods, regional cerebral oxygen saturation (rcSO 2 ) can provide much earlier warning indications of cerebral hypoxia.…”

Section: Introductionmentioning

confidence: 99%

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Midterm cerebral outcomes of Stanford type A aortic dissection in patients who underwent novel triple‐branched stent graft implantation combined with intraoperative monitoring of regional cerebral oxygen saturation

Lin

Chen

et al. 2019

J Card Surg

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Objective The aim of this study was to evaluate the cerebral outcomes of patients underwent novel triple‐branched stent graft implantation combined with the intraoperative monitoring of regional cerebral oxygen saturation. Methods One hundred thirty‐seven consecutive patients who underwent the surgery of triple‐branched stent graft implantation in our department were enrolled in this retrospective case‐control study. The patients in group A received brain protection based on the intraoperative monitoring of regional cerebral oxygen saturation and the patients in group B received conventional brain protection. The general clinical data, the types of corrective surgeries, the intraoperative situations, the postoperative complications, and the midterm outcomes of the patients were analyzed. Results The incidence of postoperative cerebral dysfunction in the patients of group A was significantly lower than that in the patients in group B (3.2% vs 14.9%, P = .020). We found significant differences in the incubation times (30.3 ± 22.1 vs 42.3 ± 27.9 hours, P = .014), the lengths of intensive care unit stay (58.0 ± 54.3 vs 79.7 ± 55.5 hours, P = .004), and the hospital stays (19.3 ± 6.7 vs 24.9 ± 17.3 days, P = .045). A descending trend in the mortality rates was observed between the patients in the two groups based on the 20 months of observation; however, this trend was not statistically significant (1.6% vs 6.8%, P = .218). Conclusions The novel triple‐branched stent graft implantation procedure combined with intraoperative monitoring of the regional cerebral oxygen saturation was an effective treatment for Stanford type A aortic dissection, with a relatively low incidence of postoperative cerebral dysfunction.

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Efficiency of Modified Triple-Branched Stent Graft in Type I Aortic Dissection: Two-Year Follow-up

Qiu

Liao

Xiao

et al. 2020

The Annals of Thoracic Surgery

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Ascending Aorta and Hemiarch Replacement Combined With Modified Triple-Branched Stent Graft Implantation for Repair of Acute DeBakey Type I Aortic Dissection

Cited by 51 publications

References 21 publications

Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

Midterm cerebral outcomes of Stanford type A aortic dissection in patients who underwent novel triple‐branched stent graft implantation combined with intraoperative monitoring of regional cerebral oxygen saturation

Efficiency of Modified Triple-Branched Stent Graft in Type I Aortic Dissection: Two-Year Follow-up

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