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, 潘旭東, 董松波, 等. 急性A型主動脈夾層孫氏術后低氧血癥的相關因素分析. 心肺血管病雜志, 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, 張超, 韓冬, 等. Stanford A型急性主動脈夾層孫氏手術后低氧血癥危險因素探討. 心肺血管病雜志, 2021, 40(1): 53-55, 63.
10.	郭偉, 郭俊曉, 劉志平. Standford A型急性主動脈夾層術后低氧血癥相關危險因素分析. 內蒙古醫科大學學報, 2020, 42(3): 229-233, 238.
11.	孫舸. StanfordA型夾層術后并發低氧血癥的危險因素分析. 大連醫科大學, 2013.
12.	林麗珠, 梁蓓薇, 梁東科, 等. Stanford A型主動脈夾層術后低氧血癥的圍手術期危險因素分析. 中國醫師進修雜志, 2018, 41(1): 25-29.
13.	黃思納, 歐斌, 張劍彬. StanfordA型主動脈夾層術后重度低氧血癥的危險因素分析. 嶺南心血管病雜志, 2018, 24(4): 433-436.
14.	宋先榮, 程兆云, 韓宇, 等. 急性A型主動脈夾層術后低氧血癥的相關因素及對策. 中國心臟大會2014論文匯編, 2014: 306.
15.	周楚芝, 王湘, 姜妮, 等. 急性A型主動脈夾層孫氏術后低氧血癥的危險因素分析. 嶺南心血管病雜志, 2017, 23(2): 165-170.
16.	王冀, 張海濤. 術前腎功能不全與主動脈夾層術后低氧血癥發生率的關聯性研究. 中國臨床醫生雜志, 2019, 47(1): 30-33.
17.	郝智鵬, 王詠, 朱雨, 等. Stanford A型主動脈夾層術后重度低氧血癥臨床分析. 第三軍醫大學學報, 2020, 42(9): 929-936.
18.	鞠帆, 劉楠, 潘旭東, 等. Stanford A型主動脈夾層術后重度低氧血癥風險預測模型的探索. 中華醫學雜志, 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.	張歡歡, 楊玉金, 張加樂, 等. 急性主動脈夾層發生低氧血癥患者危險因素的Meta分析. 中國現代醫學雜志, 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, 潘旭東, 董松波, 等. 急性A型主動脈夾層孫氏術后低氧血癥的相關因素分析. 心肺血管病雜志, 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, 張超, 韓冬, 等. Stanford A型急性主動脈夾層孫氏手術后低氧血癥危險因素探討. 心肺血管病雜志, 2021, 40(1): 53-55, 63.
10. 郭偉, 郭俊曉, 劉志平. Standford A型急性主動脈夾層術后低氧血癥相關危險因素分析. 內蒙古醫科大學學報, 2020, 42(3): 229-233, 238.
11. 孫舸. StanfordA型夾層術后并發低氧血癥的危險因素分析. 大連醫科大學, 2013.
12. 林麗珠, 梁蓓薇, 梁東科, 等. Stanford A型主動脈夾層術后低氧血癥的圍手術期危險因素分析. 中國醫師進修雜志, 2018, 41(1): 25-29.
13. 黃思納, 歐斌, 張劍彬. StanfordA型主動脈夾層術后重度低氧血癥的危險因素分析. 嶺南心血管病雜志, 2018, 24(4): 433-436.
14. 宋先榮, 程兆云, 韓宇, 等. 急性A型主動脈夾層術后低氧血癥的相關因素及對策. 中國心臟大會2014論文匯編, 2014: 306.
15. 周楚芝, 王湘, 姜妮, 等. 急性A型主動脈夾層孫氏術后低氧血癥的危險因素分析. 嶺南心血管病雜志, 2017, 23(2): 165-170.
16. 王冀, 張海濤. 術前腎功能不全與主動脈夾層術后低氧血癥發生率的關聯性研究. 中國臨床醫生雜志, 2019, 47(1): 30-33.
17. 郝智鵬, 王詠, 朱雨, 等. Stanford A型主動脈夾層術后重度低氧血癥臨床分析. 第三軍醫大學學報, 2020, 42(9): 929-936.
18. 鞠帆, 劉楠, 潘旭東, 等. Stanford A型主動脈夾層術后重度低氧血癥風險預測模型的探索. 中華醫學雜志, 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. 張歡歡, 楊玉金, 張加樂, 等. 急性主動脈夾層發生低氧血癥患者危險因素的Meta分析. 中國現代醫學雜志, 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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