Aim To determine risk factors responsible for developing postoperative complications after the thoracic aorta reconstructive surgery. Methods Medical records of 100 patients, who had undergone elective or emergency thoracic aorta reconstructive surgery at the Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, were analysed. Intraoperative data as cross-clamp time (CCT), duration of cardiopulmonary bypass (CPBT) and hypothermic circulatory arrest time (HCAT) were evaluated. Univariate analysis was used to show risk factors for developing postoperative cardiac, respiratory, surgical and renal complications. Results Between May 2019 and April 2021, 48 Bentall procedures (BP), 23 ascending aortic replacements (AAR), 20 BP and coronary artery bypass grafting (CABG) and 9 aortic valve replacements (AVR) with AAR were performed. Incidence of postoperative complications in the elective and emergency groups was as follows: respiratory 20% vs 38% (p=0.049), cardiac 18% vs 70% (p=0.015), renal 16% vs 48% (p=0.027) and surgical 4% vs 6% (p>0.05). Intrahospital 30 days morbidity was 44% with mortality rate of 13%. The results showed that CPBT>180 minutes was a risk factor for respiratory (p=0.034), cardiac (p=0.020) and renal (p=0.027) postoperative complications after acute type A aortic dissection surgery. Conclusion CPBT > 180 min is a risk factor for postoperative development of respiratory, cardiac and renal complications. Postoperative cardiac and renal complications were associated with longer HCAT.
Shultz B, Timek T, Davis AT, Heiser J, Murphy E, Willekes C, et al. Outcomes in patients undergoing complex cardiac repairs with cross clamp times over 300 minutes. J Cardiothorac Surg 2016;11;(105).
2
Liu Y, Chen K, Mei W. Neurological complications after cardiac surgery: anesthetic considerations based on outcome evidence. Curr Opin Anaesthesiol 2019;32:563–7.
3
Raffa GM, Angello F, Occhipinti G, Miraglia R, Re VL, Marrone G, et al. Neurological complications after cardiac surgery: a retrospective case-control study of risk factors and outcome. J Cardiothorac Surg 2019;14;(23).
4
Ji Q, Mei Y, Wang X, Feng J, Cai J, Ding W. Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Int J Med Sci 2013;10:1578–83.
5
Naveed A, Azam H, Murtaza HG, Ahmad RA, Baig MAR. Incidence and risk factors of pulmonary complications after cardiopulmonary bypass. Pac J Med Sci 2017;33:993–6.
6
Jamil DD, Baram A, Saqat BH. Impact of prolonged cardiopulmonary bypass and operative exposure time on the incidence of surgical site infections in patients undergoing open heart surgery: Single center case series. Int J Surg 2020;20:52–6.
7
Lannemyr L, Lundin E, Reinsfelt B, Bragadottir G, Redfors B, Oras J, et al. Renal tubular injury during cardiopulmonary bypass as assessed by urinary release of N-acetyl-ß-D-glucosaminidase. Acta Anesthesiol Scand 2017;61:1075–83.
8
Xu S, Liu J, Li L, Wu Z, Li J, Liu Y, et al. Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study. J Cardiothorac Surg 2019;14;(90).
9
Nadeem R, Agarwal S, Jawed S, Yasser A, Altahmody K. Impact of cardiopulmonary bypass time on postoperative duration of mechanical ventilation in patients undergoing cardiovascular surgeries: A systemic review and regression of metadata. Cureus 2019;11:e6088.
10
Salsano A, Giacobbe DR, Sportelli E, Olivieri GM, Natali R, Prevosto M, et al. Aortic cross-clamp time and cardiopulmonary bypass time: prognostic implications in patients operated on for infective endocarditis. Interact Cardiovasc Thorac Surg 2018;27:328–35.
11
Kuang J, Yang J, Wang Q, Yu C, Li Y, Fan R. A preoperative mortality risk assessment model for Stanford type A acute aortic dissection. BMC Cardiovasc Disord 2020;20;(508).
12
Madhavan S, Chan SP, Tan WC, Eng J, Li B, Luo HD, et al. Cardiopulmonary bypass time: every minute counts. J Card Surg 2018;59:274–81.
13
Xue Y, Tang X, Zhu X, Lu Y, Zhang H, Xie W, et al. Prompt surgery is effective for acute type A aortic dissection with cerebral ischemia. J Thorac Dis 2021;13:1403–12.
14
Wang Z, Ge M, Wang Z, Chen C, Lu L, Zhang L, et al. Identification of risk factors for postoperative stage 3 acute kidney injury in patients who received surgical repair for acute type A aortic dissection. BMC Surg 2022;22;(75).
15
Moller CM, Ellmauer PP, Zeman F, Bitzinger D, Florchinger B, Graf BM, et al. Postoperative acute respiratory dysfunction and the influence of antibiotics after acute type A aortic dissection surgery: A retrospective analysis. PLoS One 2021:16 0246724.
16
Udzik J, Sienkiewicz S, Biskupski A, Szylinska A, Kowalska Z, Biskupski P. Cardiac complications following cardiac surgery procedures. J Clin Med 2020;9:e3347.
17
Lee TC, Kon Z, Cheema FH, Grau-Sepulveda MV, Englum B, Kim S, et al. Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database. J Card Surg 2018;33:7–18.
18
Young R, Ostertag H. Incidence, etiology and risk of rupture of aortic aneurysm: An autopsy study. Dtsch Med Wochenschr 1987;112:1253–6.
19
Ahmad NH, Tan TL. Aortic dissection: A life-threatening stroke mimicker. Hong Kong J Emerg Med 2017;25:98–101.
20
Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg 2016;5:275–95.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
