Pulmonary complications after descending thoracic and thoracoabdominal aortic aneurysm repair: Predictors, prevention, and treatment

被引:66
作者
Etz, Christian D.
Di Luozzo, Gabriele
Bello, Ricardo
Luehr, Maximilian
Khan, Muhammad Z.
Bodian, Carol A.
Griepp, Randall B.
Plestis, Konstadinos A.
机构
[1] CUNY Mt Sinai Sch Med, Dept Cardiothorac Surg, New York, NY 10029 USA
[2] CUNY Mt Sinai Sch Med, Dept Anesthesiol, New York, NY 10029 USA
[3] Montefiore Med Ctr, Dept Cardiothorac Surg, New York, NY USA
关键词
D O I
10.1016/j.athoracsur.2006.10.099
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Although recent advances in surgical techniques have improved outcomes of descending thoracic (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair, significant mortality and morbidity still occur. The aim of the current retrospective study is to determine predictors of postoperative pulmonary complications and prolonged hospital stay. Methods. Two hundred nineteen patients (median age, 66 years; range, 18 to 88; 112 male) underwent DTA (n = 79 [36%; 23 elephant trunk completions]) or TAAA (n = 140 [64%; Crawford I (52%), II (10%), III (11%), IV (7%); 31 elephant trunk completions]) between June 2002 and June 2005. Forty-one patients presented with ruptured aneurysms. Left atrial-to-femoral bypass was utilized in 51% of the patients. Femoro-femoral bypass and distal aortic perfusion were used in 41% of the patients, deep hypothermic circulatory arrest (DHCA) was used in 43 patients (mean duration: 31 +/- 9 minutes); 8% were done with clamp- and-sew technique. Results. Adverse outcomes were seen in 21 patients (9.5%); hospital death in 13 (5.9%), and stroke in 13 (5 of whom died; 5.9%). Sixty patients (27%) experienced respiratory complications with prolonged postoperative ventilation (longer than 48 hours); 24 required tracheostomy (11%). Independent predictors of pulmonary complications after DTA/TAAA were TAAA (p = 0.03), preoperative blood urea nitrogen greater than 24 mg/dL (p = 0.03) and rupture (p =s 0.09). The median hospital stay was 11 days (interquartile range, 6 to 35). Independent predictors of length of hospital stay were preoperative blood urea nitrogen (p = 0.045), postoperative bleeding (p < 0.005), reintubation (p = 0.001), tracheostomy (p < 0.0005), and transfusion of platelets (p = 0.008). Conclusions. This contemporary experience demonstrates that preoperative renal insufficiency and extensive aneurysm are important predictors of respiratory complications after aortic aneurysm surgery.
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收藏
页码:S870 / S876
页数:7
相关论文
共 23 条
[1]   Thoracoabdominal aneurysm repair: Results with 337 operations performed over a 15-year interval [J].
Cambria, RP ;
Clouse, WD ;
Davison, JK ;
Dunn, PF ;
Corey, M ;
Dorer, D .
ANNALS OF SURGERY, 2002, 236 (04) :471-479
[2]   Thoracoabdominal aortic aneurysm repair: Review and update of current strategies [J].
Coselli, JS ;
Conklin, LD ;
LeMaire, SA .
ANNALS OF THORACIC SURGERY, 2002, 74 (05) :S1881-S1884
[3]   Discussion: Session 4 - Descending/thoracoabdominal aorta [J].
Coselli, JS ;
Jacobs, M ;
Dion, R ;
Karck, M ;
Done, C ;
Elefteriades, JA ;
Kouchoukos, NT ;
Gill, IS .
ANNALS OF THORACIC SURGERY, 2002, 74 (05) :S1892-S1898
[4]   Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: Hospital and surgeon volume-related outcomes [J].
Cowan, JA ;
Dimick, JB ;
Henke, PK ;
Huber, TS ;
Stanley, JC ;
Upchurch, GR .
JOURNAL OF VASCULAR SURGERY, 2003, 37 (06) :1169-1174
[5]   THORACOABDOMINAL AORTIC-ANEURYSMS - PREOPERATIVE AND INTRAOPERATIVE FACTORS DETERMINING IMMEDIATE AND LONG-TERM RESULTS OF OPERATIONS IN 605 PATIENTS [J].
CRAWFORD, ES ;
CRAWFORD, JL ;
SAFI, HJ ;
COSELLI, JS ;
HESS, KR ;
BROOKS, B ;
NORTON, HJ ;
GLAESER, DH .
JOURNAL OF VASCULAR SURGERY, 1986, 3 (03) :389-404
[6]  
Ergin M A, 1991, Semin Thorac Cardiovasc Surg, V3, P293
[7]   Surgical treatment of the dilated ascending aorta: When and how? [J].
Ergin, MA ;
Spielvogel, D ;
Apaydin, A ;
Lansman, SL ;
McCullough, JN ;
Galla, JD ;
Griepp, RB .
ANNALS OF THORACIC SURGERY, 1999, 67 (06) :1834-1839
[8]  
Ergin MA, 1999, ANN THORAC SURG, V67, P1853
[9]  
Galla JD, 1997, J CARDIAC SURG, V12, P292
[10]   Use of somatosensory evoked potentials for thoracic and thoracoabdominal aortic resections [J].
Galla, JD ;
Ergin, MA ;
Lansman, SL ;
McCullough, JN ;
Nguyen, KH ;
Spielvogel, D ;
Klein, JJ ;
Griepp, RB .
ANNALS OF THORACIC SURGERY, 1999, 67 (06) :1947-1952