Risk factors for postoperative hypoxemia in patients with Stanford type A aortic dissection: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIANG Yuping , LUO Tianhui ,  ZENG Ling , DAI Xiaorong

Department of Intensive Care Unit/School of Nursing of West China, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

ZENG Ling, Email: zengling510@163.com

Keywords：

Stanford type A aortic dissection; postoperation; hypoxemia; risk factor; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202112062

Video：

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Objective To systematically evaluate the risk factors for hypoxemia after Stanford type A aortic dissection (TAAD) surgery. Methods Electronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and CBM were searched by computer to collect studies about risk factors for hypoxemia after TAAD published from inception to November 2021. Two authors independently assessed the studies' quality, and a meta-analysis was performed by RevMan 5.3 software. Results A total of 19 case-control studies involving 2 686 patients and among them 1 085 patients suffered hypoxemia, included 21 predictive risk factors. The score of Newcastle-Ottawa scale≥7 points in 16 studies. Meta-analysis showed that: age (OR=1.10, 95%CI 1.06 to 1.14, P＜0.000 01), body mass index (OR=1.87, 95%CI 1.49 to 2.34, P＜0.000 01), preoperative partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO₂/FiO₂)≤300 mm Hg (OR=7.13, 95%CI 3.48 to 14.61, P＜0.000 01), preoperative white blood cell count (OR=1.34, 95%CI 1.18 to 1.53, P＜0.000 1), deep hypothermic circulatory arrest time (OR=1.33, 95%CI 1.14 to 1.57, P=0.000 4), perioperative blood transfusion (OR=1.89, 95%CI 1.49 to 2.41, P＜0.000 01), cardiopulmonary bypass time (OR=1.02, 95%CI 1.00 to 1.03, P=0.02) were independent risk factors for hypoxemia after TAAD surgery. Preoperative serum creatinine, preoperative myoglobin, preoperative alanine aminotransferase were not associated with postoperative hypoxemia. Conclusion Current evidence shows that age, body mass index, preoperative PaO₂/FiO₂≤300 mm Hg, preoperative white blood cell count, deep hypothermic circulatory arrest time, perioperative blood transfusion, cardiopulmonary bypass time are risk factors for hypoxemia after TAAD surgery. These factors can be used to identify high-risk patients, and provide guidance for medical staff to develop perioperative preventive strategy to reduce the incidence of hypoxemia. The results should be validated by higher quality researches.

Citation： XIANG Yuping, LUO Tianhui, ZENG Ling, DAI Xiaorong. Risk factors for postoperative hypoxemia in patients with Stanford type A aortic dissection: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1483-1489. doi: 10.7507/1007-4848.202112062 Copy

1.	Cheng SW, Ting AC, Tsang SH. Epidemiology and outcome of aortic aneurysms in Hong Kong. World J Surg, 2003, 27(2): 241-245.
2.	Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: Perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg, 2009, 37(2): 149-159.
3.	Liu N, Zhang W, Ma W, et al. Risk factors for hypoxemia following surgical repair of acute type A aortic dissection. Interact Cardiovasc Thorac Surg, 2017, 24(2): 251-256.
4.	于子翔, 潘旭东, 董松波, 等. 急性A型主动脉夹层孙氏术后低氧血症的相关因素分析. 心肺血管病杂志, 2020, 39(6): 711-715.
5.	Sheng W, Yang HQ, Chi YF, et al. Independent risk factors for hypoxemia after surgery for acute aortic dissection. Saudi Med J, 2015, 36(8): 940-946.
6.	Shen Y, Liu C, Fang C, et al. Oxygenation impairment after total arch replacement with a stented elephant trunk for type-A dissection. J Thorac Cardiovasc Surg, 2018, 155(6): 2267-2274.
7.	Gong M, Wu Z, Xu S, et al. Increased risk for the development of postoperative severe hypoxemia in obese women with acute type A aortic dissection. J Cardiothorac Surg, 2019, 14(1): 81.
8.	Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med, 1994, 149(3 Pt 1): 818-824.
9.	王登峰, 张超, 韩冬, 等. Stanford A型急性主动脉夹层孙氏手术后低氧血症危险因素探讨. 心肺血管病杂志, 2021, 40(1): 53-55, 63.
10.	郭伟, 郭俊晓, 刘志平. Standford A型急性主动脉夹层术后低氧血症相关危险因素分析. 内蒙古医科大学学报, 2020, 42(3): 229-233, 238.
11.	孙舸. StanfordA型夹层术后并发低氧血症的危险因素分析. 大连医科大学, 2013.
12.	林丽珠, 梁蓓薇, 梁东科, 等. Stanford A型主动脉夹层术后低氧血症的围手术期危险因素分析. 中国医师进修杂志, 2018, 41(1): 25-29.
13.	黄思纳, 欧斌, 张剑彬. StanfordA型主动脉夹层术后重度低氧血症的危险因素分析. 岭南心血管病杂志, 2018, 24(4): 433-436.
14.	宋先荣, 程兆云, 韩宇, 等. 急性A型主动脉夹层术后低氧血症的相关因素及对策. 中国心脏大会2014论文汇编, 2014: 306.
15.	周楚芝, 王湘, 姜妮, 等. 急性A型主动脉夹层孙氏术后低氧血症的危险因素分析. 岭南心血管病杂志, 2017, 23(2): 165-170.
16.	王冀, 张海涛. 术前肾功能不全与主动脉夹层术后低氧血症发生率的关联性研究. 中国临床医生杂志, 2019, 47(1): 30-33.
17.	郝智鹏, 王咏, 朱雨, 等. Stanford A型主动脉夹层术后重度低氧血症临床分析. 第三军医大学学报, 2020, 42(9): 929-936.
18.	鞠帆, 刘楠, 潘旭东, 等. Stanford A型主动脉夹层术后重度低氧血症风险预测模型的探索. 中华医学杂志, 2016, 96(13): 1001-1006.
19.	Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg, 2013, 8: 118.
20.	Nakajima T, Kawazoe K, Izumoto H, et al. Risk factors for hypoxemia after surgery for acute type A aortic dissection. Surg Today, 2006, 36(8): 680-685.
21.	Zhou J, Pan J, Yu Y, et al. Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection. Ann Palliat Med, 2021, 10(7): 7388-7397.
22.	Xi X, Chen Y, Ma WG, et al. Is obstructive sleep apnoea associated with hypoxaemia and prolonged ICU stay after type A aortic dissection repair? A retrospective study in Chinese population. BMC Cardiovasc Disord, 2021, 21(1): 421.
23.	张欢欢, 杨玉金, 张加乐, 等. 急性主动脉夹层发生低氧血症患者危险因素的Meta分析. 中国现代医学杂志, 2018, 28(19): 67-74.
24.	Kordonowy LL, Burg E, Lenox CC, et al. Obesity is associated with neutrophil dysfunction and attenuation of murine acute lung injury. Am J Respir Cell Mol Biol, 2012, 47(1): 120-127.
25.	Jo Y, Anzai T, Sugano Y, et al. Early use of beta-blockers attenuates systemic inflammatory response and lung oxygenation impairment after distal type acute aortic dissection. Heart Vessels, 2008, 23(5): 334-340.
26.	Merry HE, Phelan P, Doak MR, et al. Role of toll-like receptor-4 in lung ischemia-reperfusion injury. Ann Thorac Surg, 2015, 99(4): 1193-1199.
27.	Deng Y, Hou L, Xu Q, et al. Cardiopulmonary bypass induces acute lung injury via the high-mobility group box 1/toll-like receptor 4 pathway. Dis Markers, 2020, 2020: 8854700.
28.	Xing Z, Han J, Hao X, et al. Immature monocytes contribute to cardiopulmonary bypass-induced acute lung injury by generating inflammatory descendants. Thorax, 2017, 72(3): 245-255.
29.	Lee YL, King MB, Gonzalez RP, et al. Blood transfusion products contain mitochondrial DNA damage-associated molecular patterns: A potential effector of transfusion-related acute lung injury. J Surg Res, 2014, 191(2): 286-289.

1. Cheng SW, Ting AC, Tsang SH. Epidemiology and outcome of aortic aneurysms in Hong Kong. World J Surg, 2003, 27(2): 241-245.
2. Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: Perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg, 2009, 37(2): 149-159.
3. Liu N, Zhang W, Ma W, et al. Risk factors for hypoxemia following surgical repair of acute type A aortic dissection. Interact Cardiovasc Thorac Surg, 2017, 24(2): 251-256.
4. 于子翔, 潘旭东, 董松波, 等. 急性A型主动脉夹层孙氏术后低氧血症的相关因素分析. 心肺血管病杂志, 2020, 39(6): 711-715.
5. Sheng W, Yang HQ, Chi YF, et al. Independent risk factors for hypoxemia after surgery for acute aortic dissection. Saudi Med J, 2015, 36(8): 940-946.
6. Shen Y, Liu C, Fang C, et al. Oxygenation impairment after total arch replacement with a stented elephant trunk for type-A dissection. J Thorac Cardiovasc Surg, 2018, 155(6): 2267-2274.
7. Gong M, Wu Z, Xu S, et al. Increased risk for the development of postoperative severe hypoxemia in obese women with acute type A aortic dissection. J Cardiothorac Surg, 2019, 14(1): 81.
8. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med, 1994, 149(3 Pt 1): 818-824.
9. 王登峰, 张超, 韩冬, 等. Stanford A型急性主动脉夹层孙氏手术后低氧血症危险因素探讨. 心肺血管病杂志, 2021, 40(1): 53-55, 63.
10. 郭伟, 郭俊晓, 刘志平. Standford A型急性主动脉夹层术后低氧血症相关危险因素分析. 内蒙古医科大学学报, 2020, 42(3): 229-233, 238.
11. 孙舸. StanfordA型夹层术后并发低氧血症的危险因素分析. 大连医科大学, 2013.
12. 林丽珠, 梁蓓薇, 梁东科, 等. Stanford A型主动脉夹层术后低氧血症的围手术期危险因素分析. 中国医师进修杂志, 2018, 41(1): 25-29.
13. 黄思纳, 欧斌, 张剑彬. StanfordA型主动脉夹层术后重度低氧血症的危险因素分析. 岭南心血管病杂志, 2018, 24(4): 433-436.
14. 宋先荣, 程兆云, 韩宇, 等. 急性A型主动脉夹层术后低氧血症的相关因素及对策. 中国心脏大会2014论文汇编, 2014: 306.
15. 周楚芝, 王湘, 姜妮, 等. 急性A型主动脉夹层孙氏术后低氧血症的危险因素分析. 岭南心血管病杂志, 2017, 23(2): 165-170.
16. 王冀, 张海涛. 术前肾功能不全与主动脉夹层术后低氧血症发生率的关联性研究. 中国临床医生杂志, 2019, 47(1): 30-33.
17. 郝智鹏, 王咏, 朱雨, 等. Stanford A型主动脉夹层术后重度低氧血症临床分析. 第三军医大学学报, 2020, 42(9): 929-936.
18. 鞠帆, 刘楠, 潘旭东, 等. Stanford A型主动脉夹层术后重度低氧血症风险预测模型的探索. 中华医学杂志, 2016, 96(13): 1001-1006.
19. Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg, 2013, 8: 118.
20. Nakajima T, Kawazoe K, Izumoto H, et al. Risk factors for hypoxemia after surgery for acute type A aortic dissection. Surg Today, 2006, 36(8): 680-685.
21. Zhou J, Pan J, Yu Y, et al. Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection. Ann Palliat Med, 2021, 10(7): 7388-7397.
22. Xi X, Chen Y, Ma WG, et al. Is obstructive sleep apnoea associated with hypoxaemia and prolonged ICU stay after type A aortic dissection repair? A retrospective study in Chinese population. BMC Cardiovasc Disord, 2021, 21(1): 421.
23. 张欢欢, 杨玉金, 张加乐, 等. 急性主动脉夹层发生低氧血症患者危险因素的Meta分析. 中国现代医学杂志, 2018, 28(19): 67-74.
24. Kordonowy LL, Burg E, Lenox CC, et al. Obesity is associated with neutrophil dysfunction and attenuation of murine acute lung injury. Am J Respir Cell Mol Biol, 2012, 47(1): 120-127.
25. Jo Y, Anzai T, Sugano Y, et al. Early use of beta-blockers attenuates systemic inflammatory response and lung oxygenation impairment after distal type acute aortic dissection. Heart Vessels, 2008, 23(5): 334-340.
26. Merry HE, Phelan P, Doak MR, et al. Role of toll-like receptor-4 in lung ischemia-reperfusion injury. Ann Thorac Surg, 2015, 99(4): 1193-1199.
27. Deng Y, Hou L, Xu Q, et al. Cardiopulmonary bypass induces acute lung injury via the high-mobility group box 1/toll-like receptor 4 pathway. Dis Markers, 2020, 2020: 8854700.
28. Xing Z, Han J, Hao X, et al. Immature monocytes contribute to cardiopulmonary bypass-induced acute lung injury by generating inflammatory descendants. Thorax, 2017, 72(3): 245-255.
29. Lee YL, King MB, Gonzalez RP, et al. Blood transfusion products contain mitochondrial DNA damage-associated molecular patterns: A potential effector of transfusion-related acute lung injury. J Surg Res, 2014, 191(2): 286-289.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for postoperative hypoxemia in patients with Stanford type A aortic dissection: A systematic review and meta-analysis

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