Surgical repair of acute type a aortic dissection: continuous pulmonary perfusion during retrograde cerebral perfusion prevents lung injury in a pilot study

Santo, Luca Salvatore De; Romano, Gianpaolo; Amarelli, Cristiano; Torella, Michele; Renzulli, Attilio; Galdieri, Nicola; Cotrufo, Maurizio

doi:10.1016/s0022-5223(03)00583-x

Cited by 20 publications

(15 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A prospective study by De Santo et al analysed the effect of pulmonary perfusion during hypothermic circulatory arrest on postoperative respiratory function after type A aortic dissection surgery [16]. Pulmonary perfusion during circulatory arrest has been demonstrated to preserve better lung function in patients with acute type A aortic dissection, but was not used in the current study.…”

Section: Discussionmentioning

confidence: 97%

Acute respiratory dysfunction after surgery for acute type A aortic dissection

Girdauskas¹,

Kuntze²,

Borger³

et al. 2010

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Objective: Acute respiratory dysfunction (ARD) can occur after acute type A aortic dissection, but relatively little is known about ARD in such patients. This study aims to analyse the clinical impact of ARD after surgery for acute type A aortic dissection and to assess possible treatment options. Methods: We reviewed our institutional database to identify patients who underwent surgery for acute type A dissection between October 1994 and January 2008 (n = 276). Postoperative ARD was defined as oxygenation impairment (PaO 2 /FiO 2 <150) that occurred within 72 h of surgery and was not related to other documented causes of acute respiratory failure. Results: A total of 37 patients (13%) (27 male, mean age 60.7 AE 11 years) experienced ARD after surgery for acute type A dissection. Intensive care unit stay was significantly longer for patients with ARD than those without (18 AE 11 days vs 7.5 AE 6 days, respectively, p < 0.0001). However, hospital mortality was not significantly different between groups (16% for ARD patients vs 19% for patients without ARD, p = 0.6). Logistic regression analysis identified preoperative multiple malperfusion as the only risk factor for ARD (OR 3.2, 95% confidence interval (C.I.): 2.2-4.9). Peak C-reactive protein levels were significantly higher in ARD patients (17.7 AE 6.7 vs 9.6 AE 5.4 mg dl À1 , p = 0.04). Prone positioning ventilation was performed in 15 patients (40%) with severely impaired oxygenation and resulted in an immediate increase in mean oxygenation index from 71.6 AE 8.8 to 138 AE 92.6 ( p < 0.001). There was a tendency towards a shorter total time of mechanical ventilation (355 AE 188 h vs 433 AE 318 h, p = 0.2) and shorter ICU stay (405 AE 198 h vs 505 AE 265 h, p = 0.2) in the prone positioning subgroup. Conclusions: ARD is a relatively common complication of surgery for acute type A dissection and is associated with increased morbidity and resource utilisation. Patients with preoperative malperfusion are at increased risk for development of ARD. Prone positioning is a viable treatment option that significantly improves pulmonary oxygenation. #

show abstract

Section: Discussionmentioning

confidence: 97%

Acute respiratory dysfunction after surgery for acute type A aortic dissection

Girdauskas¹,

Kuntze²,

Borger³

et al. 2010

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Although deep hypothermia and antegrade selective cerebral perfusion may preserve better cerebral function during circulatory arrest, the malperfusion of other organs may still lead to generally ischemic reperfusion injury. A prospective study by De Santo et al analysed the effect of pulmonary perfusion during hypothermic circulatory arrest which may preserve better lung function but that was not used in our study [28]. …”

Section: Discussionmentioning

confidence: 99%

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

Wang

Xue

Zhu

2013

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundThe 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.MethodsClinical 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).ResultsWe 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.ConclusionOur 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.

show abstract

“…After verifying haemodynamic stability, the patients were always placed at a position of 458. Principles of postoperative care were previously reported and comply with published guidelines [6,7]. Antibiotic prophylaxis was based on a single b-lactam antibiotic and routine mupirocin administration.…”

Section: Study Setting and Populationmentioning

confidence: 99%

Microbiologically documented nosocomial infections after cardiac surgery: an 18-month prospective tertiary care centre report☆☆☆★

Santo

Bancone

Santarpino

et al. 2008

European Journal of Cardio-Thoracic Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

Surgical repair of acute type a aortic dissection: continuous pulmonary perfusion during retrograde cerebral perfusion prevents lung injury in a pilot study

Abstract: Continuous pulmonary perfusion provided a better preservation of lung function in patients operated on with deep systemic hypothermia.

Cited by 20 publications

References 17 publications

Acute respiratory dysfunction after surgery for acute type A aortic dissection

Acute respiratory dysfunction after surgery for acute type A aortic dissection

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

Microbiologically documented nosocomial infections after cardiac surgery: an 18-month prospective tertiary care centre report☆☆☆★

Contact Info

Product

Resources

About