[EngO3] English Session3

[EngO3-1] Clinical analysis of prolonged mechanical ventilation＞72hrs following acute type A aortic dissection repair

Genta Chikazawa, Kentaro Tamura, Arudo Hiraoka, Toshinori Totsugawa, Atsuhisa Ishida, Satoko Ishii, Taichi Sakaguchi, Hidenori Yoshitaka (Department of Cardiovascular Surgery and Surgical ICU, The Sakakibara Heart Institute of Okayama, Japan)

Background The aim of this study was to clarify influencing factors of prolonged mechanical ventilation (PMV) following acute type A aortic dissection repair (AAADR) on clinical outcomes. Methods and results A total of 325 patients who underwent AAADR in our institute between 2009 and 2017 were enrolled. They were divided into two groups based on the duration of mechanical ventilation ; 72h or less (Group A; n=250) and more than 72h (Group B; n=75). Multivariate analysis was utilized to identify influencing factors of PMV. Clinical outcomes were compared between both groups. Preoperative backgrounds showed the percentages of those with chronic obstructive pulmonary disease (COPD) (13% vs 3%, p=0.002), redo operative cases (8% vs 1%, p=0.006), mal-perfusion to coronary arteries (11% vs 1%, p<0.001) or lower limbs (20% vs 8%,p=0.004) were significantly higher in Group B than in Group A. Procedure related data revealed that operation time (OT) (min) (485±140 vs 387±97, p<0.001), cardio-pulmonary bypass time(min) (251±78, 212±57, p<0.001), aortic cross clamp time(min) (156±52 vs 132±36, p<0.001) , and postoperative ICU stay(days) (34±20 vs 27±16, p<0.001) were significantly longer in group B than in group A. There were more intraoperative bleeding amounts (IBM) (ml) (3128±1852 vs 2093±1314, p<0.001) identified in Group B. The percentages of those complicated with postoperative acute kidney injury (AKI) (17% vs 1%, p<0.001) were significantly higher in Group B. 30-day mortality was significantly higher in Group B than in Group A (23% vs 5%, p<0.001). Multivariate analysis demonstrated that COPD (p=0.004), preoperative mal-perfusion to vital organs or lower limbs (p=0.009), OT (min) (p=0.039), and IBM (ml) (p=0.036) were significantly influencing factors of PMV. 5-year overall survival (44.2% vs 68%, Log rank-test;P<0.001) was significantly worse in Group B than in Group A. Conclusions In the present study, COPD, mal-perfusion to vital organs or lower limbs, prolonged OT, exacerbated IBM were considered to be influencing factors of PMV. Identifying these factors could help to establish optimal perioperative management strategies following AAADR.