Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection

Background: To explore the risk factors for and the prognosis of postoperative acute respiratory distress syndrome (ARDS) in patients with Stanford type A aortic dissection (AD). Methods: This retrospective nested case-control study included 527 Stanford type A AD patients who were divided into ARDS groups and non-ARDS groups. The clinical features of the groups were examined. Results: The fifty-nine patients in the ARDS group exhibited extended durations of cardiopulmonary bypass (CPB) (P=0.004), deep hypothermic circulatory arrest (DHCA) (P=0.000), ventilator support (P=0.013) and intensive care unit (ICU) stay (P=0.045), higher hospital costs (P=0.000), larger perioperative transfusions volumes [red blood cells (RBC): P=0.002, platelets (PLT): P=0.040, fresh frozen plasma (FFP): P=0.001], more frequent pulmonary infection (P=0.018) and multiple organ dysfunction syndrome (MODS) (P=0.040) and a higher rate of in-hospital mortality (P=0.020). The ARDS group exhibited worse statuses in terms of oxygenation index (OI) values (P=0.000) and Apache II scores (P=0.000). DHCA [P=0.000, odds ratio (OR) =2.589] and perioperative transfusion (RBC: P=0.000, OR =2.573; PLT: P=0.027, OR =1.571; FFP: P=0.002, OR =1.929) were independent risk factors for postoperative ARDS. The survival rates and median survival times after discharge were similar between the two groups (P=0.843). Conclusions: DHCA duration and perioperative transfusion volume were independent risk factors for postoperative ARDS which warrants greater attention by the cardiac surgeons.