title: Analysis of the risk factors of postoperative respiratory dysfunction of type A aortic dissection and lung protection.
abstract: OBJECTIVE
  Retrospectively to analyze the risk factors of postoperative respiratory dysfunction (RD) in 196 patients with type A dissection operated on with cerebral perfusion and a lower body hypothermia circulatory arrest (HCA) and to investigate the method of the lung protection.
  
  
  METHODS
  From January 2005 to April 2008, 196 patients with type A dissection underwent surgical repair with cerebral perfusion and HCA. There were 142 male patients and 54 female patients, with ages from 17 to 78 years. Antegrade selective cerebral perfusion (SCP) through the axillary artery was performed for 168 patients and retrograde cerebral perfusion (RCP) from the superior vena cava for 28 patients. All the factors underwent univariate and multivariate analysis.
  
  
  RESULTS
  Mean cardiopulmonary bypass (CPB) duration was (186+/-56) minutes and mean cerebral perfusion time was (35+/-15) minutes; mean HCA time was (39+/-14) minutes. Postoperative RD was detected in 26 patients (13.3%). Multivariate analysis showed that the longer duration of circulatory arrest (CA), P=0.008, OR=1.048, and the higher temperature in the bladder during CA, P=0.002, OR=1.614, were independent risk factors of postoperative RD. There was a higher mortality (23.1%, P=0.025) in patients with postoperative RD when compared with the other patients.
  
  
  CONCLUSIONS
  The longer duration of CA and the higher temperature in the bladder during CA were found to be the independent risk factors of postoperative RD after type A aortic dissection surgery. Attention should be paid to lung protection for these patients and the adjunct of continuing descending aortic perfusion and cerebral perfusion should be a safe and feasible procedure and it would be valuable to perform a prospective trial.
authors.affiliation: Zhong Shan Hospital, Fu Dan University, Shang Hai, 20032, China.
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Luo
authors.forename: Ke-Jian
authors.initials: KJ
authors.lastname: Hu
authors.forename: Jin-Yuan
authors.initials: JY
authors.lastname: Zhou
authors.forename: Chun-Sheng
authors.initials: CS
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012120:Respiration Disorders / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult