Increased risk for the development of postoperative severe hypoxemia in obese women with acute type a aortic dissection

Gong, Ming; Wu, Zining; Xu, Shijun; Li, Lei; Wang, Xiaolong; Guan, Xinliang; Zhang, Hongjia

doi:10.1186/s13019-019-0888-9

Cited by 30 publications

(40 citation statements)

References 23 publications

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“…We reasoned that since most of our patients transported from other hospitals takes a long time from symptom onset to entering the operating room, which would put the patients at a higher risk to develop the postoperative hypoxemia. Herein, we illustrated that higher BMI was linked to developing postoperative hypoxemia and severe hypoxemia in line with previous studies (8)(9)(10)(11)(12). Obesity, defined as BMI >25 kg/m 2 , had significant adverse effects on cardiopulmonary physiology.…”

Section: Discussionsupporting

confidence: 86%

“…Our study illustrated that the incidence of such complication was 84% (63/75), much higher than previous studies (30-50%) (6-11). However, the incidence of severe hypoxemia (P/F <100 mmHg) was 32% (24/75) in our study, slightly lower than a recent study (36.6%) (12). We reasoned that since most of our patients transported from other hospitals takes a long time from symptom onset to entering the operating room, which would put the patients at a higher risk to develop the postoperative hypoxemia.…”

Section: Discussioncontrasting

confidence: 80%

“…Several risk factors of postoperative hypoxemia for ATAAD patients, such as obesity, female, preoperative PaO 2 /FiO 2 ratio ≤300 mmHg, blood transfusion, have been investigated in some studies; however, the results remain controversial (6)(7)(8)(9)(10)(11)(12). Through retrospective analysis of patients' data, to determine the risk factors of hypoxemia and its severity can help clinicians to adjust treatment strategies and avoid the occurrence of hypoxemia.…”

Section: Introductionmentioning

confidence: 99%

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Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection

Zhou¹,

Pan²,

Yu³

et al. 2021

Ann Palliat Med

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Background: This study aimed to investigate independent risk factors of postoperative hypoxemia in patients with acute type A aortic dissection (ATAAD).Methods: A single-center retrospective study was conducted with enrolled 75 ATAAD patients following surgery, which were stratified into three groups on the basis of the postoperative PaO 2 /FiO 2 ratio: severe hypoxemia group (PaO 2 /FiO 2 ratio ≤100 mmHg); moderate hypoxemia group (100 mmHg < PaO 2 /FiO 2 ratio ≤200 mmHg); and non-hypoxemia group (PaO 2 /FiO 2 ratio >200 mmHg). The patient's demography, perioperative laboratory results, operative details, clinical outcomes were collected and analyzed. Univariable and multivariable analyses were performed and logistic regression model was established. Results:The incidence of postoperative severe hypoxemia and hypoxemia was 32% and 52%, respectively. Among the three groups, severe hypoxemia group exhibited a high significance of body mass index (BMI) and preoperative white blood cell (WBC) and main distribution of hypertension; meanwhile, Marfan syndrome was mainly distributed in non-hypoxemia group. On intensive care unit (ICU) admission, severe hypoxemia group exhibited a high significance of Acute Physiology and Chronic Health Evaluation (APACHE II) score of postoperative patients, and more patients would present shock. Moreover, severe hypoxemia group patients had a higher incidence of postoperative acute kidney injury (AKI) and usage of renal replacement therapy, longer length of stay (LOS) of ICU, and shorter 28 days ventilator-free days (VFDs). Conclusions:The incidence of postoperative hypoxemia was high in ATAAD patients owing to comprehensive high-risk factors. Besides, postoperative complications negatively impacted their clinical outcomes.

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Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection

Zhou¹,

Pan²,

Yu³

et al. 2021

Ann Palliat Med

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“…Previous studies, as well as the present study, have shown CPB time to be significantly prolonged among obese compared with non-obese patients. 14 – 16 Cooling and rewarming tend to be prolonged in obese patients. We recently reported that double arterial cannulation yielded acceptable outcomes and seems effective for the prevention and management of intraoperative malperfusion.…”

Section: Discussionmentioning

confidence: 99%

Effects of Obesity on Outcomes of Acute Type A Aortic Dissection Repair in Japan

et al. 2020

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Background: The prevalence of obesity among Japanese acute type A aortic dissection (ATAAD) patients and its effect on repair outcomes remain to be elucidated. Methods and Results: The prevalence of obesity (body mass index [BMI] ≥30.0 kg/m 2 ) among 1,059 patients (mean [±SD] age 64.3±12.7 years) who underwent ATAAD repair between 1990 and 2018 was compared with that among the general Japanese population (National Health and Nutrition Survey data). The prevalence of obesity among male patients (17.1% [6/35], 20.0% [18/90], and 14.4% [20/139] for those aged 20–39, 40–49, and 50–59 years, respectively) was significantly higher than that among the age- and sex-matched general population. The 1,059 patients were divided into groups according to weight (normal [BMI <25.0 kg/m 2 ; n=742], overweight [BMI 25.0–29.9 kg/m 2 ; n=248], or obese [BMI ≥30.0 kg/m 2 ; n=69]). Comparing the normal weight, overweight, and obese groups revealed significant differences among the 3 groups in median cardiopulmonary bypass time (143, 167, and 183 min, respectively), ventilation >48 h (44.5%, 60.1%, and 78.3%, respectively), and in-hospital mortality (7.0%, 7.3%, and 17.4%, respectively), but not in 30-day survival. Shock, visceral malperfusion, operation time >360 min, obesity, and coronary malperfusion were identified as predictors of in-hospital mortality. Conclusions: The prevalence of obesity is increased among Japanese male patients with ATAAD aged ≤59 years. Obesity may increase these patients’ operative risk; overweight does not.

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“…Of 64 studies reporting outcomes of patients included in this report 13–76 . The proportions of studies from Asia, Europe, and North America were 54.7%, 31.3%, and 10.9%, respectively.…”

Section: Methodsmentioning

confidence: 99%

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

et al. 2021

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Background and Aim of the Study The frozen elephant trunk (FET) procedure became a popular entity for utilization in aortic arch aneurysm disease. However, its proper mortality and morbidities as well as the predictors of outcomes are poorly identified. This systematic review and meta‐analysis explore FET outcomes and its predictors with a focus on zone aortic proximalization. Methods We searched PubMed/MEDLINE, EMBASE, and Scopus databases from their beginning to June 2020 to find studies reporting the outcomes of the FET procedure for the total arch replacement (TAR). Results A total of 64 studies including 7967 patients were evaluated. The pooled estimates of cerebrovascular accidents, paraplegia, renal failure, and in‐hospital mortality were 7.104 (95% confidence interval [CI], 5.691–8.661; I2 = 78.53%), 3.465 (95% CI, 2.852–4.136; I2 = 15.96), 14.969 (95% CI, 11.361–18.977; I2 = 91.26%), and 8.933 (95% CI, 7.128–10.919; I2 = 78.51%), respectively. Stratification by the geographical locations and by the aortic pathologies led to lower heterogeneity, but not for renal failure. The distal anastomosis in Zone 2 was associated with a lower rate of renal failure compared with Zone 3 (odds ratio, 0.54; 95% CI, 0.36–0.81; p = .003; I2 = 0%). Conclusions The FET procedure for TAR can be performed with acceptable mortality and morbidities among patients with complex aortic pathologies. Moreover, the distal anastomosis in Zone 2 was associated with lower renal failure compared to Zone 3.

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Increased risk for the development of postoperative severe hypoxemia in obese women with acute type a aortic dissection

Cited by 30 publications

References 23 publications

Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection

Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection

Effects of Obesity on Outcomes of Acute Type A Aortic Dissection Repair in Japan

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

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