Risk Factors Associated with Prolonged Mechanical Ventilation and Prolonged Postoperative Hospital Stay after Ozaki...

This study evaluated medium and long-term postoperative results to identify perioperative factors that are associated with prolonged mechanical ventilation (PMV) and prolonged postoperative hospital stay (PPH) in pediatric patients with aortic valve disease (AVD) undergoing Ozaki procedure. We retrospectively reviewed the medical records of 129 patients who underwent the Ozaki procedure between January 2017 to July 2025. The cohort was divided into a PMV group that included patients with ≥ 75th (20.5 h) percentile for duration of mechanical ventilation and a Non-PMV group which included all other patients. Similarly, the cohort was divided into a PPH group that included patients with ≥ 75th (14d) percentile for duration of postoperative hospital stay and a Non-PPH group which included all other patients. There were 36 cases (27.91%) with postoperative PMV and 34 cases (26.36%) with postoperative PPH. There was no death in the non-PMV group, while 2 patients in the PMV group died in hospital and 1 patient underwent heart transplantation during follow-up. One patient in the PPH group and one in the non-PPH group died in hospital, and one patient in the PPH group underwent transplantation during follow-up. Patients in the PMV or PPH group were younger, had lower body weight, had lower preoperative LVEF, had more concomitant procedures, had longer cardiopulmonary bypass time, longer aortic cross-clamp time, longer operation time, longer cardiac intensive care unit stay, longer mechanical ventilation time, longer postoperative hospital stay, a higher rate of delayed chest closure and a higher rate of early reoperation, However, during follow-up, the results were similar to those of the control group for moderate or greater aortic valve stenosis or regurgitation, aortic valve dysfunction, neoaortic valve reoperation, late any reoperation and death/transplantation after surgery. In a multivariable model, low age [OR:0.796(0.651-0.974), P = 0.026], truncus arteriosus [OR:57.382(1.821-1808.547), P = 0.021], mixed lesion [OR:20.529(2.978-141.531), P = 0.002], longer aortic cross-clamp time [OR:1.010(1.003-1.016), P = 0.003], more replaced leaflets [OR:3.140(1.374-7.178), P = 0.007], smaller postoperative ascending aorta diameter [OR:0.818(0.704-0.951), P = 0.009] and longer cardiac intensive care unit stay [1.102(1.022-1.189), P = 0.012] were independent risk factors for PMV; longer cardiac intensive care unit stay was risk factor [OR: 1.467(1.251-1.720), P < 0.001] for PPH, whereas larger postoperative ascending aorta diameter was protective [OR:0.860(0.770-0.960), P = 0.007]. In children undergoing Ozaki procedure for AVD, PMV after surgery should be monitored in patients with low age, truncus arteriosus, mixed lesion, longer aortic cross-clamp time, more replaced leaflets, smaller postoperative ascending aorta diameter and longer cardiac intensive care unit stay, PPH after surgery should be monitored in patients with smaller postoperative ascending aorta diameter and longer cardiac intensive care unit stay.