Risk factors of acute respiratory dysfunction after a type aortic dissection surgery / 中华胸心血管外科杂志

ABSTRACT

Objective Acute respiratory dysfunction (ARD) can occur after aortic surgery with the use of cardiopulmonary bypass and deep hypothermic circulation arrest, but relatively little is known about acute respiratory dysfunction in the patients with type A aortic dissection. This study aims to analyze the independent risk factors of acute respiratory dysfunction after A type aortic dissection surgery and to assess possible prevention and treatment option in the future. Methods Clinical data of the 252 patients including 193 male patients and 59 female patients who underwent type A aortic dissection surgery from February 2009 to October 2010 were collected. The mean age was 47 years. Postoperative acute respiratory dysfunction was defined as oxygenation impairment (PaO2/FiO2 ＜ 150) that occurred within 72 h of surgery except pleural effusion, cardiogenic pulmonary edema, pneumonia, pulmonary embolism and haemato-/ pneumothorax. There were 187 acute A type aortic dissection patients and 65 chronic type A aortic dissection patients. Clinical characteristics including age, gender, weight, height, history of hypertension, history of smoking, preoperative complications such as preoperative shock and acute renal failure, pericardial effusion, previous cardiac surgery, time from event to surgery, malperfusion syndrome, cardiopulmonary time, cross-clamp time,deep hypothermia circulation arrest time, surgical procedure, duration of intensive care unit stay and postoperative complications including tracheotomy, dialysis dependent renal failure and hospital mortality were gathered. Arterial blood analysis, chest X ray, ventilator parameters, number of blood transfusion and flood balance were assayed after operation. All the factors were evaluated by means of univariate and multivariate logistic regression analysis to identify relative risk factors of ARD. Results Acute respiratory dysfunction occurred in 32 (12.7% ) patients. The in-hospital mortality was significant difference between acute respiratory dysfunction group and non- acute respiratory dysfunction group (P ＜ 0.05). The value of BMI, incidence of acute aortic dissection, preoperative SBP level, cardio-pulmonary bypass time, aortic clamp time and total arch replacement in acute respiratory dysfunction group were significantly higher than the values in non- acute respiratory dysfunction group. Multivariate Logistic regression analysis showed blood transfusion more than 10 units and cardio-pulmonary bypass time more than 160 minutes were independent risk factors of early stage acute respiratory dysfunction after type A aortic dissection surgery.Conclusion Acute respiratory dysfunction after type A aortic dissection was a severe early stage postoperative complication and was associated with in-hospital mortality. The patients in acute aortic dissection were prone to have acute respiratory dysfunction. The independent risk factors of acute respiratory dysfunction included blood transfusion more than 10 units and cardio-pulmonary bypass time more than 160 minutes.