Complications And Related Risk Factors After Pulmonary Endarterectomy

Incidence and risk factors for acute kidney injury following pulmonary endarterectomy surgeryObjective:Acute kidney injury(AKI)is a major postoperative morbidity of patients undergoing cardiac surgery and has a negative effect on prognosis.The kidney outcomes after pulmonary endarterectomy(PEA)have not yet been reported.The objective of our study was to identify the incidence and risk factors for postoperative AKI and its association with short-term outcomes.Methods:A total of 123 patients with PEA surgery from 2014 to 2018 at Fuwai hospital were included in this retrospective study.Assessments of AKI diagnosis was executed based on the Kidney Disease Improving Global Outcomes(KDIGO)criteria.logistic regression was applied to identify risk factors for AKI.Results:The incidence of postoperative AKI was 45%in the study population.Stage 3 AKI was associated with worse short-term outcomes and 90-day mortality(p<0.001,p=0.002,respectively).The independent predictors of postoperative AKI were the preoperative platelet count(OR 0.992;95%CI 0.984-0.999;p=0.022),preoperative hemoglobin concentration(OR 0.969;95%CI 0.946-0.993;p=0.01)and deep hypothermic circulatory arrest(DHCA)time(OR 1.197;95%CI 1.052-1.362;p=0.006)in multivariate analysis.The area under the curve of ROC for AKI was 0.737(95%CI,0.642-0.831)and the Hosmer-Lemeshow goodness-of-fit statistic p value was greater than 0.05.Conclusions:The incidence of postoperative AKI was relatively high after PEA compared with other types of cardiothoracic surgeries.The preoperative platelet count,preoperative hemoglobin concentration and DHCA duration were modifiable predictors of AKI,and patients may benefit from some low-risk,low cost perioperative measures.Risk factors for prolonged Prolonged mechanical ventilation following pulmonary endarterectomy surgeryObjectives:Prolonged mechanical ventilation(PMV)is common after cardiothoracic surgery.We aim to identify the incidence and risk factors for PMV and the relationship between PMV and short-term outcomes.Methods:We studied a retrospective cohort of 171 who undergoing PEA surgery from 2014 to 2020.Cox regression with restricted cubic splines was performed to identify the cutoff value for PMV.The Least absolute shrinkage and selection operator regression and logistic regressions were applied to identify risk factors for PMV The impacts of PMV on the short-term outcomes were evaluated.Results:PMV was defined as the duration of mechanical ventilation exceeding 48 hours.Independent risk factors for PMV included female sex(OR 2.911;95%CI 1.303-6.501;p=0.009),deep hypothermic circulatory arrest(DHCA)time(OR 1.027;95%CI 1.002-1.053;p=0.036),postoperative blood product use(OR 2.911;95%CI 1.303-6.501;p=0.009),postoperative total bilirubin levels(OR 1.021;95%CI 1.007-1.034;p=0.002),preoperative pulmonary artery pressure(PAP)(OR 1.031;95%CI 1.014-1.048;p<0.001),and postoperative right ventricular anteroposterior dimension(RVAD)(OR 1.119;95%CI 1.026-1.221;p=0.011).Patients with PMV had longer intensive care unit stays,higher incidences of postoperative complications,and higher in-hospital medical expenses.Conclusions:Female sex,prolonged DHCA time,increased postoperative blood product use,elevated postoperative total bilirubin levels,increased preoperative PAP and elongated postoperative RVAD were independent risk factors for PMV Identification of risk factors associated with PMV in patients undergoing PEA may facilitate timely diagnosis and re-intervention for some of these modifiable factors to decrease ventilation time and improve patient outcomes.Progress in complications following Pulmonary endarterectomyPulmonary endarterectomy(PEA)is internationally recognized as the gold standard for the treatment of Chronic thromboembolic pulmonary hypertension(CTEPH)patients.With the development of operation skills and improving of perioperative management strategies,the prognosis of patients after PEA surgery has been improved.However,complications after PEA still bring great challenges to the postoperative management.Active prevention of these complications can significantly reduce the mortality and hospital costs after PEA.This review summarizes our current knowledge about complications after PEA,which is expected to provide reference for clinical practice.