scholarly journals Postoperative liver dysfunction after total arch replacement combined with frozen elephant trunk implantation: incidence, risk factors and outcomes

2019 ◽  
Vol 29 (6) ◽  
pp. 930-936 ◽  
Author(s):  
Lijing Yang ◽  
Jun Li ◽  
Guyan Wang ◽  
Hui Zhou ◽  
Zhongrong Fang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Bypass ◽  
Liver Dysfunction ◽  
Multivariable Analysis ◽  
Total Arch Replacement ◽  
Frozen Elephant Trunk ◽  
Erythrocyte Transfusion ◽  
Elephant Trunk ◽  
Postoperative Liver Dysfunction ◽  
Independent Risk Factors

Abstract OBJECTIVES The authors aimed to clarify the incidence and risk factors of postoperative liver dysfunction (PLD) in patients undergoing total arch replacement combined with frozen elephant trunk implantation and to determine the association of PLD with short-term outcomes. METHODS Data from 672 adult patients undergoing total arch replacement with frozen elephant trunk from January 2013 until December 2016 at Fuwai Hospital were analysed retrospectively. A multivariable logistic regression model was used to identify the risk factors for PLD. RESULTS The overall incidence of PLD was 27.5%, which was associated with higher in-hospital mortality (PLD 4.9% vs No PLD 0.8%, P = 0.002) and 30-day mortality (PLD 9.2% vs No PLD 2.5%, P < 0.001) and a higher incidence of major adverse events (PLD 54.6% vs No PLD 23.4%, P < 0.001). In the multivariable analysis, preoperative hypotension [odds ratio (OR) 1.97, 95% confidence interval (CI) 1.14–3.41; P = 0.02), coronary artery disease (OR 2.64, 95% CI 1.17–5.96; P = 0.02), prolonged cardiopulmonary bypass duration (OR 1.01, 95% CI 1.00–1.01; P < 0.001), increased preoperative alanine transferase (OR 1.01, 95% CI 1.00–1.01; P < 0.001), preoperative platelet count <100 × 109/l (OR 3.99, 95% CI 1.74–9.14; P = 0.001) and increased intraoperative erythrocyte transfusion (OR 1.07, 95% CI 1.01–1.12; P = 0.02) were identified as independent risk factors for PLD. CONCLUSIONS PLD was associated with increased mortality and morbidity. Among the independent risk factors for PLD, cardiopulmonary bypass duration and erythrocyte transfusion could be modifiable. A skilled surgical team and an ideal blood protection strategy may be helpful to protect liver function.

scholarly journals Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection

2021 ◽  
Vol 8 ◽  
Author(s):  
Shenghua Liang ◽  
Yanxiang Liu ◽  
Bowen Zhang ◽  
Yaojun Dun ◽  
Hongwei Guo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Bypass ◽  
Hepatic Dysfunction ◽  
Celiac Trunk ◽  
Early Mortality ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aspartate Transferase ◽  
Reduced Risk

Background: This study was aimed to investigate the incidence, risk factors, and outcomes of patients with postoperative hepatic dysfunction (PHD) after frozen elephant trunk (FET) for type A aortic dissection (TAAD).Method: A retrospective study was performed with 492 patients who underwent FET for TAAD between 2015 and 2019. Independent risk factors for PHD were determined by multivariate mixed-effect logistic analysis with surgeon-specific factor as a random effect.Results: The incidence of PHD was 25.4% (n = 125) in our cohort. Patients with PHD presented higher early mortality (10.4 vs. 1.1%, p &lt; 0.001), rates of acute kidney injury (42.4 vs. 12.8%, p &lt; 0.001), and newly required dialysis (23.2 vs. 3.0%, p &lt; 0.001) compared with those without PHD. Moreover, with the median follow-up period of 41.3 months, the survival curve was worse in patients with PHD compared with no PHD group (log-rank p &lt; 0.001), whereas it was similar after excluding patients who died within 30 days (log-rank p = 0.761). Multivariable analyses suggested that PHD was predicted by preoperative aspartate transferase [odds ratio (OR), 1.057; 95% confidence intervals (CI), 1.036–1.079; p &lt; 0.001], celiac trunk malperfusion (OR, 3.121; 95% CI, 1.008–9.662; p = 0.048), and cardiopulmonary bypass time (OR, 1.014; 95% CI, 1.005–1.023; p = 0.003). Retrograde perfusion (OR, 0.474; 95% CI, 0.268–0.837; p = 0.010) was associated with a reduced risk of PHD. Celiac trunk malperfusion was an independent predictor for PHD but not associated with early mortality and midterm survival.Conclusions: PHD was associated with increased early mortality and morbidity, but not with late death in midterm survival. PHD was predicted by preoperative aspartate transferase, celiac trunk malperfusion, and cardiopulmonary bypass (CPB) time, and retrograde perfusion was associated with a reduced risk of PHD.

scholarly journals Urgent Frozen Elephant Trunk for an Aortic Arch Pseudoaneurysm Secondary to Fractured Sternal Wire

2021 ◽  
Author(s):  
Filippos - Paschalis Rorris ◽  
Pantelis Tsipas ◽  
Konstantinos Velissarios ◽  
Theodoros Kratimenos ◽  
Lydia Kokotsaki ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Aortic Arch ◽  
Total Arch Replacement ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Careful Planning ◽  
Rare Presentation ◽  
Aortic Pseudoaneurysm ◽  
Two Stages

Pseudoaneurysms of the aorta are rare complications of cardiac surgery, and sternal re-entry to address the pathology is particularly challenging. In this case, we describe a rare presentation of thoracic aortic pseudoaneurysm due to chronic erosion from a sternal wire, 10 years following the index operation. The patient was treated in two-stages, including carotid-subclavian bypass, followed by sternal re-entry with total arch replacement and frozen elephant trunk, employing cardiopulmonary bypass via femoral and axillary cannulation. Despite the high risks of rupture/haemorrhage associated with sternal re-entry, operative success for aortic pseudoaneurysms can be achieved with careful planning and safe bypass strategies.

scholarly journals Thromboembolic Events in Patients with Testicular Germ Cell Tumours Are Predominantly Triggered by Advanced Disease and by Central Venous Access Systems

2020 ◽  
pp. 1-7
Author(s):  
Klaus-Peter Dieckmann ◽  
David Marghawal ◽  
Uwe Pichlmeier ◽  
Christian Wülfing
Keyword(s):  
Risk Factors ◽  
Central Venous Access ◽  
Multivariable Analysis ◽  
Venous Access ◽  
Germ Cell Tumours ◽  
Thromboembolic Events ◽  
Central Venous ◽  
Testicular Germ Cell ◽  
Testicular Germ Cell Tumours ◽  
Independent Risk Factors

<b><i>Background:</i></b> Thromboembolic events (TEEs) may significantly complicate the clinical management of patients with testicular germ cell tumours (GCTs). We analysed a cohort of GCT patients for the occurrence of TEEs and looked to possible pathogenetic factors. <b><i>Patients, Methods:</i></b> TEEs occurring within 6 months after diagnosis were retrospectively analysed in 317 consecutive patients with testicular GCT (median age 37 years, 198 seminoma, 119 nonseminoma). The following factors were analysed for association with TEE: histology, age, clinical stage (CS), chemotherapy, use of a central venous access device (CVA). Data analysis involved descriptive statistical methods with multivariable analysis to identify independent risk factors. <b><i>Results:</i></b> Twenty-three TEEs (7.3%) were observed, 18 deep vein thromboses, 4 pulmonary embolisms, and 1 myocardial infarction. Univariable risk calculation yielded the following odds ratios (ORs) : &#x3e;CS1 OR = 43.7 (95% confidence intervals [CIs] 9.9–191.6); chemotherapy OR = 7.8 (95% CI 2.3–26.6); CVA OR = 30.5 (95% CI 11.0–84.3). Multivariable analysis identified only CS &#x3e; 1 (OR = 16.9; 95% CI 3.5–82.4) and CVA (OR = 9.0; 95% CI 2.9–27.5) as independent risk factors. <b><i>Conclusions:</i></b> Patients with CSs &#x3e;CS1 are at significantly increased risk of TEEs even without chemotherapy. Particular high risk is associated with the use of CVA devices for chemotherapy. Caregivers of GCT patients must be aware of the particular risk of TEEs.

90 Socio-Demographic and Medical Factors in A Multi-Ethnic Cohort of COVID Deaths

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
M Patel ◽  
U Umasankar ◽  
B McCall
Keyword(s):  
Risk Factors ◽  
South Asian ◽  
Multivariable Analysis ◽  
Uneventful Recovery ◽  
Asian Ethnicity ◽  
Black African ◽  
Medical Factors ◽  
Multivariable Analyses ◽  
Independent Risk Factors ◽  
Medical Wards

Abstract Introduction Whilst most patients during the COVID pandemic made an uneventful recovery,there was a significant minority in whom the disease was severe and unfortunately fatal. This survey aims to examine and evaluate risk factors for those patients who died of COVID and to identify any markers for improvement in the management of such patients during future COVID surges. Methods Medical records of all patients who died within a multi-ethnic, inner city acute district general hospital over a 6-week period in 2020 were examined. Data collected included demographic details, medical comorbidities, and type of ward where they received care. Multivariable analysis using stepwise backward logistic regression was conducted to examine independent risk factors for these patients. Results Of 275 deaths,204 were related to COVID. Compared to non-COVID deaths(n = 71), there were no age differences. There were significantly more deaths in males (58%vs39%,P &lt; 0.001)) and in Black African and South Asian groups. 18% of COVID deaths were those who were not frail (Frailty Rockwood Scale 1–3) whereas there were no non-COVID deaths in this group(P &lt; 0.001). 69% of COVID deaths occurred in general medical wards whereas 19% in critical care units (90% and 7% for non-COVID deaths,p &lt; 0.001). COVID patients died more quickly compared to non-COVID patients (length of stay mean, 11vs21,p &lt; 0.001). Medical factors prevalent in &gt;20% of COVID deaths included Diabetes, Hypertension, Chronic Heart Disease, Chronic Kidney Disease,and Dementia. Multivariable analyses showed males (OR 1.9), age &gt; 70(OR 2.0), frailty (OR 2.3) were independent risk factors for COVID deaths. Discussion Compared to non-COVID deaths,COVID deaths were more common in previously well individuals,males,Black African and South Asian ethnicity, but multivariable analyses showed males, age &gt; 70 and frailty were independent risk factors for COVID deaths. This survey indicates that greater psychological support may be required for healthcare workers on general medical wards who looked after greater proportion of COVID deaths.

scholarly journals Pulmonary infection after cardiopulmonary bypass surgery in children: a risk estimation model in China

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chunnian Ren ◽  
Chun Wu ◽  
Zhengxia Pan ◽  
Quan Wang ◽  
Yonggang Li
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Bypass ◽  
Prediction Model ◽  
Congenital Heart ◽  
Bypass Surgery ◽  
Pulmonary Infection ◽  
Regression Analyses ◽  
Cardiopulmonary Bypass Surgery ◽  
Independent Risk Factors ◽  
Individualized Prediction

Abstract Objectives The occurrence of pulmonary infection after congenital heart disease (CHD) surgery can lead to significant increases in intensive care in cardiac intensive care unit (CICU) retention time, medical expenses, and risk of death risk. We hypothesized that patients with a high risk of pulmonary infection could be screened out as early after surgery. Hence, we developed and validated the first risk prediction model to verify our hypothesis. Methods Patients who underwent CHD surgery from October 2012 to December 2017 in the Children’s Hospital of Chongqing Medical University were included in the development group, while patients who underwent CHD surgery from December 2017 to October 2018 were included in the validation group. The independent risk factors associated with pulmonary infection following CHD surgery were screened using univariable and multivariable logistic regression analyses. The corresponding nomogram prediction model was constructed according to the regression coefficients. Model discrimination was evaluated by the area under the receiver operating characteristic curve (ROC) (AUC), and model calibration was conducted with the Hosmer-Lemeshow test. Results The univariate and multivariate logistic regression analyses identified the following six independent risk factors of pulmonary infection after cardiac surgery: age, weight, preoperative hospital stay, risk-adjusted classification for congenital heart surgery (RACHS)-1 score, cardiopulmonary bypass time and intraoperative blood transfusion. We established an individualized prediction model of pulmonary infection following cardiopulmonary bypass surgery for CHD in children. The model displayed accuracy and reliability and was evaluated by discrimination and calibration analyses. The AUCs for the development and validation groups were 0.900 and 0.908, respectively, and the P-values of the calibration tests were 0.999 and 0.452 respectively. Therefore, the predicted probability of the model was consistent with the actual probability. Conclusions Identified the independent risk factors of pulmonary infection after cardiopulmonary bypass surgery. An individualized prediction model was developed to evaluate the pulmonary infection of patients after surgery. For high-risk patients, after surgery, targeted interventions can reduce the risk of pulmonary infection.

scholarly journals Total arch replacement and frozen elephant trunk for aortic dissection in aberrant right subclavian artery

2020 ◽  
Vol 58 (1) ◽  
pp. 104-111 ◽  
Author(s):  
Jian-Rong Li ◽  
Wei-Guo Ma ◽  
Yu Chen ◽  
Jun-Ming Zhu ◽  
Jun Zheng ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Subclavian Artery ◽  
Circulatory Arrest ◽  
False Lumen ◽  
Hypothermic Circulatory Arrest ◽  
Total Arch Replacement ◽  
Aberrant Right Subclavian Artery ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Artery Cannulation

Abstract OBJECTIVES Aortic dissection (AoD) in the presence of an aberrant right subclavian artery (ARSA) is very rare. Clinical experience is limited, and there is no consensus regarding the optimal management strategy. We seek to evaluate the safety and efficacy of the total arch replacement (TAR) and frozen elephant trunk (FET) technique as an approach to AoD in patients with ARSA by retrospectively analysing our single-centre experience. METHODS From 2009 to 2017, we performed TAR + FET for 22 patients with ARSA sustaining AoD (13 acute, 59.1%). The mean age was 46.0 years [standard deviation (SD) 8.3], and 19 patients were male (86.4%). ARSA orifice was dilated in 15 (68.2%) patients, and a Kommerall diverticulum was diagnosed in 13 (59.1%) patients with a mean diameter of 21.8 mm (SD 7.7; range 15–40). Surgery was performed via femoral and right/left carotid cannulation under hypothermic circulatory arrest at 25°C. The ARSA was reconstructed using a separate branched graft. RESULTS ARSA was closed proximally by ligation in 16 (72.7%) patients, direct suture in 4 (18.2%) patients and both in 2 (9.1%) patients. Operative mortality was 13.6% (3/22). Type Ib endoleak occurred in 1 (4.5%) patient at 8 days. Follow-up was complete in 100% at mean 4.2 years (SD 2.0), during which 3 late deaths and 1 reintervention for type II endoleak occurred. Survival was 81.8% and 76.4% at 3 and 5 years, respectively. Freedom from reoperation was 89.2% up to 8 years. In competing risks analysis, the incidence was 22.1% for death, 10.8% for reoperation and 67.1% for event-free survival at 5 years. The false lumen, ARSA orifice and Kommerall diverticulum were obliterated in 100%. Grafts were patent in 100%. No patients experienced cerebral ischaemia and upper extremity claudication. Hypothermic circulatory arrest time (min) was sole predictor for death and aortic reintervention (hazard ratio 1.168, 95% confidence interval 1.011–1.348; P = 0.034). CONCLUSIONS The TAR and FET technique is a safe and efficacious approach to AoD in patients with ARSA. Modifications of routine TAR + FET techniques are essential to successful repair, including femoral and right/left carotid artery cannulation, ligation of ARSA on the right side of the trachea and ARSA reconstruction with a separate graft.

scholarly journals Risk factors and prognosis of nosocomial pneumonia in patients undergoing extracorporeal membrane oxygenation: a retrospective study

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096470
Author(s):  
Jianrong Wang ◽  
Jinyu Huang ◽  
Wei Hu ◽  
Xueying Cai ◽  
Weihang Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Nosocomial Pneumonia ◽  
Discharge Rate ◽  
Multivariable Analysis ◽  
Ventilator Support ◽  
Membrane Oxygenation ◽  
Independent Risk Factors ◽  
Medical University ◽  
Vv Ecmo

Objective We aimed to examine the risk factors and prognosis of nosocomial pneumonia (NP) during extracorporeal membrane oxygenation (ECMO). Methods We retrospectively analyzed data of patients who received ECMO at the Affiliated Hangzhou Hospital of Nanjing Medical University between January 2013 and August 2019. The primary outcome was the survival-to-discharge rate. Results Sixty-nine patients who received ECMO were enrolled, median age 42 years and 26 (37.7%) women; 14 (20.3%) patients developed NP. The NP incidence was 24.7/1000 ECMO days. Patients with NP had a higher proportion receiving veno-venous (VV) ECMO (50% vs. 7.3%); longer ECMO support duration (276 vs. 140 hours), longer ventilator support duration before ECMO weaning (14.5 vs. 6 days), lower ECMO weaning success rate (50.0% vs. 81.8%), and lower survival-to-discharge rate (28.6% vs. 72.7%) than patients without NP. Multivariable analysis showed independent risk factors that predicted NP during ECMO were ventilator support duration before ECMO weaning (odds ratio [OR] = 1.288; 95% confidence interval [CI]: 1.111–1.494) and VV ECMO mode (OR = 10.970; 95% CI: 1.758–68.467). Conclusion NP during ECMO was associated with ventilator support duration before ECMO weaning and VV ECMO mode. Clinicians should shorten the respiratory support duration for patients undergoing ECMO to prevent NP.

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