Risk factors for prolonged mechanical ventilation following surgery for acute type a aortic dissection.
BACKGROUND
The aim of this study was to identify predictors of prolonged mechanical ventilation (PMV) following surgery for acute type A aortic dissection (AAAD) and to assess the influence of this complication on clinical outcomes.


RESULTS
A total of 243 patients underwent emergency surgery for AAAD in the period of 1997-2006. Ten patients died within 48 h after surgery. The remaining 233 patients were divided into 2 groups according to the duration of mechanical ventilation; less than 48 h (group A: n=149) or 48 h or longer (group B; n=84). Multivariate analysis was used to identify predictors of PMV. Short and late outcomes were compared between groups. Multivariate analysis showed that shock (systolic BP <90 mmHg; p=0.007), postoperative renal dysfunction (creatinine >2.0 mg/dl; p=0.016), coronary artery bypass grafting (CABG) (p=0.017), and limb ischemia (p=0.044) were independent predictors of PMV. There was no significant difference in in-hospital mortality (group A, 2.7% vs group B, 3.6%) or 5-year survival (group A, 85.9% vs group B, 76.8%).


CONCLUSIONS
Shock, limb ischemia, CABG, and postoperative renal dysfunction increase the risk for PMV. Knowing the predictors of PMV should help optimize postoperative management of these patients.
Kimura
Naoyuki
N
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama, Japan. kimura-n@omiya.jichi.ac.jp
Tanaka
Masashi
M
Kawahito
Koji
K
Sanui
Masamitsu
M
Yamaguchi
Atsushi
A
Ino
Takashi
T
Adachi
Hideo
H
D000208:Acute Disease; D000368:Aged; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors