Effect of sivelestat on postoperative outcomes in patients with acute type A aortic dissection and hypoxemia: a...

Preoperative hypoxemia in patients with acute type A aortic dissection (ATAAD) increases the risk of Postoperative pulmonary complications (PPCs). Sivelestat, which is used for acute lung injury has not been extensively studied in ATAAD patients who develop preoperative hypoxemia. This study first aims to evaluate the impact of sivelestat on the duration of postoperative mechanical ventilation and the length of stay in the Intensive Care Unit (ICU) for patients with ATAAD complicated by hypoxemia. Secondly, we investigate the effects of sodium sivelestat on the oxygenation index (OI, PaO₂/FiO₂) and serum inflammatory factors of patients.

In this retrospective study, 143 patients diagnosed with ATAAD undergoing total aortic arch replacement with stent grafting (Sun's) at our hospital (2021-2024) were grouped into sivelestat and non-sivelestat groups. We obtained and compared patient data including demographics, hospitalization, ventilation, and perioperative biomarkers.

In total, 79 patients (55.2%) experienced preoperative hypoxemia based on the inclusion criteria. Eventually, 65 patients were enrolled in the study after excluding 14 patients. The postoperative PaO₂/FiO₂ decreased in both groups. The postoperative PaO₂/FiO₂ was significantly higher in the sivelestat group than in the non-sivelestat group at 3d (T2), 5d (T3), and 7d (T4). White blood cell count (WBCc) and neutrophil count (NEUTc) at T3 and T4, as well as a neutrophil percentage (NEUT%) at T4 in the sivelesta group were lower than that in the non-sivelestat group. Additionally, the C-reactive protein (CRP) and Interleukin-6(IL-6) levels in the sivelesta group at T3 and T4 were reduced. The mechanical ventilation duration, ICU, and hospital length of stay in the sivelesta group were shortened. Other clinical indices displayed no significant differences.

In summary, patients with ATAAD and preoperative hypoxemia have lower postoperative PaO₂/FiO₂. Besides, sivelestat improves postoperative PaO₂/FiO₂, reduces inflammation, and shortens ventilation as well as ICU/hospital stay in ATAAD patients with preoperative hypoxemia.