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Review paper

Risk factors in the development of postoperative complications after reconstructive surgery on the thoracic aorta

By
Alisa Krdžalić Orcid logo ,
Alisa Krdžalić
Contact Alisa Krdžalić

Clinic for Cardiovascular Surgery, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Mustafa Tabaković ,
Mustafa Tabaković

Clinic for Cardiovascular Surgery, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Ivana Iveljić ,
Ivana Iveljić

Clinic for Invasive Cardiology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Ema Tahto ,
Ema Tahto

Clinic for Cardiovascular Surgery, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Goran Krdžalić
Goran Krdžalić

Polyclinic Azabagic, Tuzla, Bosnia and Herzegovina

Abstract

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.

References

1.
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. Vol. 20, BMC Cardiovasc Disord. 2020.
2.
Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Vol. 5, Ann Cardiothorac Surg. 2016. p. 275–95.
3.
Ahmad NH, Tan TL. Aortic dissection: A life-threatening stroke mimicker. Vol. 25, Hong Kong J Emerg Med. 2017. p. 98–101.
4.
Young R, Ostertag H. Incidence, etiology and risk of rupture of aortic aneurysm: An autopsy study. Vol. 112, Dtsch Med Wochenschr. 1987. p. 1253–6.
5.
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. Vol. 33, J Card Surg. 2018. p. 7–18.
6.
Udzik J, Sienkiewicz S, Biskupski A, Szylinska A, Kowalska Z, Biskupski P. Cardiac complications following cardiac surgery procedures. Vol. 9:e3347, J Clin Med. 2020.
7.
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. p. 16 0246724.
8.
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. Vol. 22, BMC Surg. 2022.
9.
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. Vol. 13, J Thorac Dis. 2021. p. 1403–12.
10.
Madhavan S, Chan SP, Tan WC, Eng J, Li B, Luo HD, et al. Cardiopulmonary bypass time: every minute counts. Vol. 59, J Card Surg. 2018. p. 274–81.
11.
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. Vol. 11, J Cardiothorac Surg. 2016.
12.
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. Vol. 27, Interact Cardiovasc Thorac Surg. 2018. p. 328–35.
13.
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. Vol. 11:e6088, Cureus. 2019.
14.
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. Vol. 14, J Cardiothorac Surg. 2019.
15.
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. Vol. 61, Acta Anesthesiol Scand. 2017. p. 1075–83.
16.
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. Vol. 20, Int J Surg. 2020. p. 52–6.
17.
Naveed A, Azam H, Murtaza HG, Ahmad RA, Baig MAR. Incidence and risk factors of pulmonary complications after cardiopulmonary bypass. Vol. 33, Pac J Med Sci. 2017. p. 993–6.
18.
Ji Q, Mei Y, Wang X, Feng J, Cai J, Ding W. Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Vol. 10, Int J Med Sci. 2013. p. 1578–83.
19.
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. Vol. 14, J Cardiothorac Surg. 2019.
20.
Liu Y, Chen K, Mei W. Neurological complications after cardiac surgery: anesthetic considerations based on outcome evidence. Vol. 32, Curr Opin Anaesthesiol. 2019. p. 563–7.

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