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Predictors of Prolonged Mechanical Ventilation in Adults After Acute Type-A Aortic Dissection Repair

Mu Jin1, Wei-Guo Ma2, Shiyao Liu3

  • 1Department of Anaesthesiology, Beijing AnZhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.

Journal of Cardiothoracic and Vascular Anesthesia
|August 7, 2017
PubMed
Abstract

Insights

Prolonged mechanical ventilation (PMV) after acute type-A aortic dissection (ATAAD) repair increases mortality. Lower preoperative platelet count and higher postoperative serum lactate are key risk factors for PMV, aiding in prevention and improved outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Prolonged mechanical ventilation (PMV) post-acute type-A aortic dissection (ATAAD) repair is linked to adverse outcomes.
  • Identifying predictors of PMV is crucial for optimizing patient management and improving survival rates.

Purpose of the Study:

  • To assess the impact of PMV on early and late outcomes following ATAAD repair.
  • To identify risk factors associated with the development of PMV in ATAAD patients.

Main Methods:

  • Retrospective analysis of prospectively collected data from 121 ATAAD patients undergoing total arch replacement with frozen elephant trunk implantation.
  • Multivariate analysis to determine risk factors for PMV and evaluate its association with mortality and survival.

Main Results:

  • 28.9% of patients required PMV, experiencing longer ICU stays and ventilation times.
  • PMV was significantly associated with increased in-hospital mortality (OR 6.4) and lower 1-year survival (77.1% vs 95.3%).
  • Independent risk factors for PMV included higher postoperative serum lactate (OR 1.189) and lower preoperative platelet count (OR 0.918).

Conclusions:

  • PMV occurs in a significant portion of ATAAD patients, negatively impacting survival.
  • Preoperative platelet count and postoperative lactate levels are modifiable risk factors for PMV.
  • Early identification and management of these risk factors can potentially reduce PMV incidence and improve patient outcomes after ATAAD repair.
Keywords:
acute type-A aortic dissectionanesthesiologyprolonged mechanical ventilation

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