Abstract
BackgroundThis cohort study aims to retrospectively investigate the incidence of severe systemic inflammatory response syndrome (sSIRS) in patients following total aortic arch replacement (TAR) under deep hypothermic circulatory arrest (DHCA) with selective cerebral perfusion and its effect on clinical outcomes.MethodsAll patients who underwent TAR with DHCA were consecutively enrolled from January 2013 until December 2015 at our institute. sSIRS was diagnosed between 12 and 48 h postoperatively if patients met all four criteria of the SIRS definition.ResultsOf the 522 patients undergoing TAR with DHCA, 31.4% developed sSIRS. Patients aged under 60 yr were characterized by a higher prevalence of sSIRS (OR = 2.93; 95% CI 2.01–4.28; P <0.001). Higher baseline serum creatinine (OR = 1.61; 95% CI 1.18–2.20; P = 0.003), concomitant coronary disease (OR = 2.00; 95% CI 1.15–3.48; P = 0.015) and extended cardiopulmonary time (OR = 1.63; 95% CI 1.23–2.18; P = 0.001) independently contributed to a greater likelihood of postoperative sSIRS onset, while the preferred administration of ulinastatin (OR = 0.69; 95% CI 0.51–0.93; P = 0.015) and dexmedetomidine (OR = 0.36; 95% CI 0.23–0.56; P < 0.001) attenuated it. Patients with sSIRS had a greater risk of developing postoperative major adverse complications compared with the no sSIRS group [56.7%(93/164) vs 26.8% (96/358), P < 0.001]. sSIRS was found to be a significant risk factor for major adverse complications (OR, 4.52; 95% CI, 3.40–6.01; P < 0.001). A significant difference was revealed in in-hospital death following TAR between the sSIRS group and the no-sSIRS group [4.88% (8/164) vs 1.12% (4/358), P = 0.019]. The Kaplan-Meier curve indicated that the time to discharge from the intensive care unit was significantly prolonged in the sSIRS group compared with patients without it (log-rank p < 0.001).ConclusionssSIRS occurs commonly in patients following TAR with DHCA. There is an inverse association between age and sSIRS onset, whereby age over 60 yr can lower the risk of it. sSIRS development can increase the likelihood of major postoperative major adverse events.
Highlights
Postoperative systemic inflammatory response syndrome (SIRS), discussed in some specific cardiovascular interventions such as transcatheter or open aortic valve repair [1,2,3], has received limited attention yet
Inflammation following total aortic arch replacement (TAR) can be incurred by operative trauma, blood exposed to cardiopulmonary bypass (CPB), infection and hypothermia, the combination of TAR and deep hypothermic circulatory arrest (DHCA) to treat aortic pathology with selective cerebral perfusion is technically preferable
Patient characteristics A total of 522 patients who underwent TAR with DHCA were included in our cohort
Summary
Patient characteristics A total of 522 patients who underwent TAR with DHCA were included in our cohort. After adjusting for covariates, including sex, age (< 60, ≥ 60 yr), BMI (< 18.5, 18.5–24.9, 25.0–29.9, 30.0–39.9, ≥ 40 kg/m2), hyperlipidemia, glucose (≤140, 141–170, 171–200 and > 200 mg/dl), moderate-severe anemia, serum creatinine, smoking, COPD, cerebral infarction, dialysis prior to surgery, hypertension, dissection, coronary disease, cardiac surgery history, aortic regurgitation, left ventricular ejection fraction, CPB duration (< 200, ≥ 200 min), and the usage of ulinastatin or dexmedetomidine, we demonstrated that patients younger than 60 yr had a nearly 3fold higher likelihood of developing sSIRS (OR = 2.93; 95% CI 2.01–4.28; P < 0.001). Major adverse events The proportion of major adverse events was significantly greater in patients suffering sSIRS compared with the nosSIRS cohort [56.7% (93/164) vs 26.8% (96/358), P < 0.001]
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