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Diaz-Castrillon CE, Brown JA, Navid F, Serna-Gallegos D, Yousef S, Thoma F, Punu K, Zhu J, Sultan I. The impact of prolonged mechanical ventilation after acute type A aortic dissection repair. J Thorac Cardiovasc Surg 2024; 167:1672-1679.e2. [PMID: 35989122 DOI: 10.1016/j.jtcvs.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/24/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Patients with type A aortic dissection have increased resource use. The objective of this study was to describe the relationship between prolonged mechanical ventilation and longitudinal survival in patients undergoing type A aortic dissection repair. METHODS We conducted a retrospective analysis of patients with type A aortic dissection undergoing repair from 2010 to 2018; Kaplan-Meier function and adjusted Cox regression analysis were used to compare in-hospital mortality and longitudinal survival accounting for time on mechanical ventilatory support. RESULTS A total of 552 patients were included. The study population was divided into 12 hours or less (n = 291), more than 12 to 24 or less hours (n = 101), more than 24 to 48 hours or less (n = 60), and more than 48 hours (n = 100) groups. Patients within the 12 or less hours group were the youngest (60.0 vs 63.5 years vs 63.6 vs 62.8 years; P = .03) and less likely to be female (31.6% vs 43.6% vs 46.7% vs 56.0%; P < .001). On the other hand, the more than 48 hours group presented with malperfusion syndrome at admission more often (24.4% vs 29.7% vs 28.3% vs 53.0%; P < .001) and had longer cardiopulmonary and ischemic times (P < .05). In-hospital mortality was significantly higher in the more than 48 hours group (5.2% vs 6.9% vs 3.3% vs 30.0%; P < .001). Multivariable analysis demonstrated worse longitudinal survival for the 24 to 48 hours group (hazard ratio, 1.94, confidence interval, 1.10-3.43) and more than 48 hours ventilation group (hazard ratio, 2.25, confidence interval, 1.30-3.92). CONCLUSIONS The need for prolonged mechanical ventilatory support is prevalent and associated with other perioperative complications. More important, after adjusting for other covariates, prolonged mechanical ventilation is an independent factor associated with increased longitudinal mortality.
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Affiliation(s)
- Carlos E Diaz-Castrillon
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Kristian Punu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Jianhui Zhu
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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Banceu C, Harpa M, Brinzaniuc K, Tilea I, Varga A, Gliga ML, Voidazan S, Neagu N, Szabo DA, Banceu D, Cristutiu D, Balmos IA, Puscas A, Oprean M, Suciu H. The Gender Gap in Aortic Dissection: A Prospective Analysis of Risk and Outcomes. J Crit Care Med (Targu Mures) 2023; 9:178-186. [PMID: 37588179 PMCID: PMC10425927 DOI: 10.2478/jccm-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
Aortic dissection (AD) is a severe cardiovascular condition that could have negative consequences. Our study employed a prospective design and examined preoperative, perioperative, and postoperative data to evaluate the effects of gender on various medical conditions. We looked at how gender affected the results of aortic dissection (AD). In contrast to female patients who had more systemic hypertension (p=0.031), male patients had higher rates of hemopericardium (p=0.003), pulmonary hypertension (p=0.039), and hemopericardium (p=0.003). Dobutamine administration during surgery significantly raised the mortality risk (p=0.015). There were noticeably more women patients (p=0.01) in the 71 to 80 age group. Significant differences in age (p=0.004), eGFR at admission (p=0.009), and eGFR at discharge (p=0.006) were seen, however, there was no association between gender and mortality. In conclusion, our findings highlight that gender may no longer be such an important aspect of aortic dissection disease as we previously thought, and this information could have an important contribution for surgeons as well as for anesthesiologists involved in the management of acute aortic dissection.
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Affiliation(s)
- Cosmin Banceu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- I.O.S.U.D George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Marius Harpa
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Klara Brinzaniuc
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Ioan Tilea
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Andreea Varga
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Mirela Liana Gliga
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Septimiu Voidazan
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Nicolae Neagu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Dan Alexandru Szabo
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Diana Banceu
- Dimitrie Cantemir University of Targu Mures, Romania
| | - Daiana Cristutiu
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Ionut Alexandru Balmos
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Alexandra Puscas
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Marvin Oprean
- Dimitrie Cantemir University of Targu Mures, Romania
| | - Horatiu Suciu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
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