Risk factors of prolonged ventilation in adults after atrioventricular septal defect operation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Shengwen ,  ZHANG Yanbo , BAI Liting , YANG Keming , HUANG Haibo , MENG Yanhai , LIU Zina

State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding?author：

ZHANG Yanbo, Email: yanbozhang@126.com

Keywords：

Adult congenital heart disease; atrioventricular septal defect; perioperative period; mechanical ventilation

DOI：

10.7507/1007-4848.201805030

Video：

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Objective To investigate the risk factors of prolonged postoperative mechanical ventilation for adult patients with atrioventricular septal defect (AVSD). Methods We retrospectively analyzed the clinical data of 76 patients with AVSD aged more than 18 years in our hospital from January 1, 2011 to December 31, 2017. The patients ventilated longer than 24 hours were described as a prolonged ventilation group (n=27) and the others as a normal group (n=49). There were 9 males and 18 females aged 32.22±9.64 years in the prolonged ventilation group, and 16 males and 33 females aged 35.98±11.34 years in the normal group. Perioperative variables between the two groups were compared and selected, and then analyzed by logistic regression analysis. Results The result of univariate analysis showed that there was a statistical difference in weight, preoperative pulmonary artery systolic pressure, duration of cardiopulmonary bypass, the level of postoperative platelet, hemoglobin, blood glucose, lactic acid and serum creatinine, postoperative maximum heart rate and postoperative infection rate between the prolonged ventilated group and the normal group. Multivarable logistic regression showed that preoperative pulmonary artery hypertension (OR=1.056, 95%CI 1.005 to 1.110, P=0.030), prolonged duration of cardiopulmonary bypass (OR=1.036, 95%CI 1.007 to 1.066, P=0.016) and the low postoperative hemoglobin level (OR=0.874, 95%CI 0.786 to 0.973, P=0.014) were the risk factors of prolonged postoperative mechanical ventilation. Conclusion Preoperative pulmonary artery hypertension, long duration of cardiopulmonary bypass and postoperative anaemia are the risk factors associated with prolonged postoperative mechanical ventilation.

Citation： GUO Shengwen, ZHANG Yanbo, BAI Liting, YANG Keming, HUANG Haibo, MENG Yanhai, LIU Zina. Risk factors of prolonged ventilation in adults after atrioventricular septal defect operation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(2): 132-136. doi: 10.7507/1007-4848.201805030 Copy

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11.	Skride A, Sablinskis K, Lejnieks A, et al. Pulmonary hypertension in adults with congenital heart disease: First data from Latvian PAH registry. Eur J Intern Med, 2016, 36: e20-e21.
12.	Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg, 2002, 21(2): 232-244.
13.	Bhatia M, Moochhala S. Role of inflammatory mediators in the pathophysiology of acute respiratory distress syndrome. J Pathol, 2004, 202(2): 145-156.
14.	Güvener M, Korun O, Demirtürk OS. Risk factors for systemic inflammatory response after congenital cardiac surgery. J Card Surg, 2015, 30(1): 92-96.
15.	Elmistekawy E, Rubens F, Hudson C, et al. Preoperative anaemia is a risk factor for mortality and morbidity following aortic valve surgery. Eur J Cardiothorac Surg, 2013, 44(6): 1051-1055.
16.	Armas-Loughran B, Kalra R, Carson JL. Evaluation and management of anemia and bleeding disorders in surgical patients. Med Clin North Am, 2003, 87(1): 229-242.
17.	Levine EA, Rosen AL, Sehgal LR, et al. Erythropoietin deficiency after coronary artery bypass procedures. Ann Thorac Surg, 1991, 51(5): 764-766.
18.	Goodnough LT, Vizmeg K, Sobecks R, et al. Prevalence and classification of anemia in elective orthopedic surgery patients: implications for blood conservation programs. Vox Sang, 1992, 63(2): 90-95.
19.	王志維, 陶衛平, 康敢軍. 重組人紅細胞生成素在體外循環圍術期中的作用. 中國胸心血管外科臨床雜志, 2002, 9(1): 72-73.

1. Wu KH, Lü XD, Liu YL. Recent progress of pediatric cardiac surgery in China. Chin Med J (Engl), 2006, 119(23): 2005-2012.
2. Rajakaruna C, Rogers CA, Angelini GD, et al. Risk factors for and economic implications of prolonged ventilation after cardiac surgery. J Thorac Cardiovasc Surg, 2005, 13(5): 1270-1277.
3. 潘沱, 王旭. 法洛四聯癥根治術后急性腎損傷的危險因素分析. 中國胸心血管外科臨床雜志, 2017, 24(7): 495-500.
4. Xie O, Brizard CP, d'Udekem Y, et al. Outcomes of repair of complete atrioventricular septal defect in the current era. Eur J Cardiothorac Surg, 2014, 45(4): 610-617.
5. Tatebe S, Saji Y, Aoki K, et al. Intermediate type atrioventricular septal defect in the elderly. Ann Thorac Surg, 2006, 81(5): 1888-1890.
6. 朱正艷, 嚴中亞, 雷虹, 等. 錯過合適年齡段完全性心內膜墊缺損外科矯治療效分析(附 15 例報告). 安徽醫學, 2013, 34(11): 1604-1606.
7. D’Alto M, Diller GP. Pulmonary hypertension in adults with congenital heart disease and Eisenmenger syndrome: current advanced management strategies. Heart, 2014, 100(17): 1322-1328.
8. Denault AY, Pearl RG, Michler RE, et al. Tezosentan and right ventricular failure in patients with pulmonary hypertension undergoing cardiac surgery: the TACTICS trial. J Cardiothorac Vasc Anesth, 2013, 27(6): 1212-1217.
9. Rosenzweig EB, Barst RJ. Congenital heart disease and pulmonary hypertension: pharmacology and feasibility of late surgery. Prog Cardiovasc Dis, 2012, 55(2): 128-133.
10. Thunberg CA, Gaitan BD, Grewal A, et al. Pulmonary hypertension in patients undergoing cardiac surgery: pathophysiology, perioperative management, and outcomes. J Cardiothorac Vasc Anesth, 2013, 27(3): 551-572.
11. Skride A, Sablinskis K, Lejnieks A, et al. Pulmonary hypertension in adults with congenital heart disease: First data from Latvian PAH registry. Eur J Intern Med, 2016, 36: e20-e21.
12. Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg, 2002, 21(2): 232-244.
13. Bhatia M, Moochhala S. Role of inflammatory mediators in the pathophysiology of acute respiratory distress syndrome. J Pathol, 2004, 202(2): 145-156.
14. Güvener M, Korun O, Demirtürk OS. Risk factors for systemic inflammatory response after congenital cardiac surgery. J Card Surg, 2015, 30(1): 92-96.
15. Elmistekawy E, Rubens F, Hudson C, et al. Preoperative anaemia is a risk factor for mortality and morbidity following aortic valve surgery. Eur J Cardiothorac Surg, 2013, 44(6): 1051-1055.
16. Armas-Loughran B, Kalra R, Carson JL. Evaluation and management of anemia and bleeding disorders in surgical patients. Med Clin North Am, 2003, 87(1): 229-242.
17. Levine EA, Rosen AL, Sehgal LR, et al. Erythropoietin deficiency after coronary artery bypass procedures. Ann Thorac Surg, 1991, 51(5): 764-766.
18. Goodnough LT, Vizmeg K, Sobecks R, et al. Prevalence and classification of anemia in elective orthopedic surgery patients: implications for blood conservation programs. Vox Sang, 1992, 63(2): 90-95.
19. 王志維, 陶衛平, 康敢軍. 重組人紅細胞生成素在體外循環圍術期中的作用. 中國胸心血管外科臨床雜志, 2002, 9(1): 72-73.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors of prolonged ventilation in adults after atrioventricular septal defect operation

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