Independent risk factors related to acute respiratory distress syndrome after acute type A aortic dissection surgery: A retrospective analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

AN Cheng , ZHANG Chengxin , SHUAI Ziqiang , LIU Can ,  GE Shenglin

Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, P. R. China;

Corresponding author：

GE Shenglin, Email: aydgsl@sina.com

Keywords：

Stanford type A aortic dissection; acute respiratory distress syndrome; oxygenation index; risk factors

DOI：

10.7507/1007-4848.202009078

Video：

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Objective To investigate the independent risk factors associated with postoperative acute respiratory distress syndrome in patients undergoing type A aortic dissection surgery.Methods The clinical data of 147 patients who underwent acute type A aortic dissection surgery in the First Affiliated Hospital of Anhui Medical University from 2015 to 2019 were retrospectively analyzed. There were 110 males at age of 51.9±10.1 years and 37 females at age of 54.3±11.1 years. According to whether the patients developed ARDS after surgery, all of the patients were divided into a ARDS group or a non-ARDS group. Logistic regress analysis was utilized to establish the predictive mode to identify the independent risk factors related to ARDS.Results Of the patients, 25 developed postoperative ARDS. Among them, 5 patients were mild ARDS, 13 patients were moderate, and 7 patients were severe ARDS. Multivariate logistic regression analysis showed that deep hypothermic circulatory arrest time [odds ratio (OR)=1.067, 95% confidence interval (CI) 1.014-1.124, P=0.013], cardiopulmonary bypass time (OR=1.012, 95%CI 1.001-1.022, P=0.027) and perioperative plasma input (OR=1.001, 95%CI 1.000-1.002, P=0.011) were independently associated with ARDS in patients undergoing acute A aortic dissection surgery. Receiver operating characteristic (ROC) curve analysis demonstrated a good discrimination ability of the logistic regression model, with an area under the curve of 0.835 (95%CI 0.740-0.929, P=0.000).Conclusion Duration of deep hypothermic circulatory arrest, cardiopulmonary bypass time and perioperative plasma are independent risk factors for postoperative ARDS in patients undergoing type A aortic dissection surgery.

Citation： AN Cheng, ZHANG Chengxin, SHUAI Ziqiang, LIU Can, GE Shenglin. Independent risk factors related to acute respiratory distress syndrome after acute type A aortic dissection surgery: A retrospective analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(4): 473-477. doi: 10.7507/1007-4848.202009078 Copy

1.	Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford vascular study. Circulation, 2013, 127(20): 2031-2037.
2.	Bashar Dib, Seppelt Philipp-Christian, Arif Rawa, et al. Extensive aortic surgery in acute aortic dissection type A on outcome-insights from 25 years single center experience. J Cardiothorac Surg, 2019, 14(1): 187.
3.	Saw LJ, Lim-Cooke MS, Woodward B, et al. The surgical management of acute type A aortic dissection: Current options and future trends. J Card Surg, 2020, 35(9): 2286-2296.
4.	Fanelli V, Vlachou A, Ghannadian S, et al. Acute respiratory distress syndrome: New definition, current and future therapeutic options. J Thorac Dis, 2013, 5(3): 326-334.
5.	Wheeler AP, Bernard GR. Acute lung injury and the acute respiratory distress syndrome: A clinical review. Lancet, 2007, 369(9572): 1553-1564.
6.	Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: The Berlin definition. JAMA, 2012, 307(23): 2526-2533.
7.	Gokalp O, Yilik L, Besir Y, et al. "Overtime hours effect" on emergency surgery of acute type A aortic dissection. Braz J Cardiovasc Surg, 2019, 34(6): 680-686.
8.	Shen Y, Liu C, Fang C, et al. Oxygenation impairment after total arch replacement with a stented elephant trunk for type-A dissection. J Thorac Cardiovasc Surg, 2018, 155(6): 2267-2274.
9.	Ming G, Wu ZN, Xu SJ, et al. Increased risk for the development of postoperative severe hypoxemia in obese women with acute type A aortic dissection. J Cardiothorac Surg, 2019, 14(1): 81.
10.	Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet, 1967, 2(7511): 319-323.
11.	Llamas R, Forthman HJ. Respiratory distress syndrome in the adult after cardiopulmonary bypass. A successful therapeutic approach. JAMA, 1973, 225(10): 1183-1186.
12.	Su IL, Wu VC, Chou AH, et al. Risk factor analysis of postoperative acute respiratory distress syndrome after type A aortic dissection repair surgery. BMC Med, 2019, 98(29): e16303.
13.	Mackie-Savage UF, Lathlean J. The long-term effects of prolonged intensive care stay postcardiac surgery. J Card Surg, 2020, 35(11): 3099-3107.
14.	Mali S, Haghaninejad H. Pulmonary complications following cardiac surgery. Arch Med Sci Atheroscler Dis, 2019, 4: e280-e285.
15.	Lackner I, Birte W, Meike B, et al. Complement activation and organ damage after trauma-differential immune response based on surgical treatment strategy. Front Immunol, 2020, 11(64): 1-14.
16.	Furusawa T, Tsukioka K, Fukui D, et al. The effects of a neutrophil elastase inhibitor on the postoperative respiratory failure of acute aortic dissection. Thorac Cardiovasc Surg, 2006, 54(6): 404-407.
17.	Merry HE, Phelan P, Doak MR, et al. Role of toll-like receptor-4 in lung ischemia-reperfusion injury. Ann Thorac Surg, 2015, 99(4): 1193-1199.
18.	Semple JW, Rebetz J, Kapur R. Transfusion-associated circulatory overload and transfusion-related acute lung injury. Blood, 2019, 133(17): 1840-1853.
19.	Chen MF, Chen LW, Cao H, et al. Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection. J Thorac Dis, 2016, 8(10): 2862-2871.

1. Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford vascular study. Circulation, 2013, 127(20): 2031-2037.
2. Bashar Dib, Seppelt Philipp-Christian, Arif Rawa, et al. Extensive aortic surgery in acute aortic dissection type A on outcome-insights from 25 years single center experience. J Cardiothorac Surg, 2019, 14(1): 187.
3. Saw LJ, Lim-Cooke MS, Woodward B, et al. The surgical management of acute type A aortic dissection: Current options and future trends. J Card Surg, 2020, 35(9): 2286-2296.
4. Fanelli V, Vlachou A, Ghannadian S, et al. Acute respiratory distress syndrome: New definition, current and future therapeutic options. J Thorac Dis, 2013, 5(3): 326-334.
5. Wheeler AP, Bernard GR. Acute lung injury and the acute respiratory distress syndrome: A clinical review. Lancet, 2007, 369(9572): 1553-1564.
6. Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: The Berlin definition. JAMA, 2012, 307(23): 2526-2533.
7. Gokalp O, Yilik L, Besir Y, et al. "Overtime hours effect" on emergency surgery of acute type A aortic dissection. Braz J Cardiovasc Surg, 2019, 34(6): 680-686.
8. Shen Y, Liu C, Fang C, et al. Oxygenation impairment after total arch replacement with a stented elephant trunk for type-A dissection. J Thorac Cardiovasc Surg, 2018, 155(6): 2267-2274.
9. Ming G, Wu ZN, Xu SJ, et al. Increased risk for the development of postoperative severe hypoxemia in obese women with acute type A aortic dissection. J Cardiothorac Surg, 2019, 14(1): 81.
10. Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet, 1967, 2(7511): 319-323.
11. Llamas R, Forthman HJ. Respiratory distress syndrome in the adult after cardiopulmonary bypass. A successful therapeutic approach. JAMA, 1973, 225(10): 1183-1186.
12. Su IL, Wu VC, Chou AH, et al. Risk factor analysis of postoperative acute respiratory distress syndrome after type A aortic dissection repair surgery. BMC Med, 2019, 98(29): e16303.
13. Mackie-Savage UF, Lathlean J. The long-term effects of prolonged intensive care stay postcardiac surgery. J Card Surg, 2020, 35(11): 3099-3107.
14. Mali S, Haghaninejad H. Pulmonary complications following cardiac surgery. Arch Med Sci Atheroscler Dis, 2019, 4: e280-e285.
15. Lackner I, Birte W, Meike B, et al. Complement activation and organ damage after trauma-differential immune response based on surgical treatment strategy. Front Immunol, 2020, 11(64): 1-14.
16. Furusawa T, Tsukioka K, Fukui D, et al. The effects of a neutrophil elastase inhibitor on the postoperative respiratory failure of acute aortic dissection. Thorac Cardiovasc Surg, 2006, 54(6): 404-407.
17. Merry HE, Phelan P, Doak MR, et al. Role of toll-like receptor-4 in lung ischemia-reperfusion injury. Ann Thorac Surg, 2015, 99(4): 1193-1199.
18. Semple JW, Rebetz J, Kapur R. Transfusion-associated circulatory overload and transfusion-related acute lung injury. Blood, 2019, 133(17): 1840-1853.
19. Chen MF, Chen LW, Cao H, et al. Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection. J Thorac Dis, 2016, 8(10): 2862-2871.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Independent risk factors related to acute respiratory distress syndrome after acute type A aortic dissection surgery: A retrospective analysis

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