Key result
Maintaining intraoperative oxygen delivery ≥280 mL/(min·m2) during cardiopulmonary bypass was associated with a 72.1% reduction in 90-day mortality in acute type A aortic dissection patients.
Why the study?
Maintaining high oxygen delivery can reduce postoperative mortality in acute type A aortic dissection, but the minimum threshold of DO2 remained unclear.
Does maintaining intraoperative DO2 ≥280 mL/(min·m2) reduce 90-day all-cause mortality in patients undergoing repair for acute type A aortic dissection?
Cohort (n=178)
No
Does maintaining intraoperative DO2 ≥280 mL/(min·m2) reduce 90-day all-cause mortality in patients undergoing repair for acute type A aortic dissection?
Effect estimate: 72.1% reduction
Maintaining an intraoperative oxygen delivery of ≥280 mL/(min·m2) during cardiopulmonary bypass for acute type A aortic dissection repair is associated with significantly reduced 90-day mortality.
Hypothesis-generating for DO2 targets in ATAAD repair; should not yet change practice pending RCTs.
Background: Acute type A aortic dissection (ATAAD) is associated with high mortality. Previous studies found that maintaining a high level of oxygen delivery (DO2) could decrease the postoperative mortality, but the minimum threshold of DO2 remained unclear. The present study aimed to investigate the relationship between maintaining intraoperative DO2 ≥280 mL/(min·m2) and the 90-day postoperative mortality of ATAAD patients. Methods: The clinical data of 178 ATAAD patients who underwent Sun’s procedure in our center from January 2018 to July 2022 were retrospectively analyzed in the present cohort study. The included patients were divided into hypoxic group [DO2 <280 mL/(min·m2)] and normoxic group [DO2 ≥280 mL/(min·m2)]. The primary endpoint was the 90-day all-cause mortality, and the secondary endpoints were postoperative mechanical ventilation time, the application of continuous renal replacement therapy (CRRT), brain complications, and other postoperative complications. Results: Among all the patients, a total of 23 patients died 90 days postoperatively. Compared with the hypoxic group, blood flow, hematocrit (HCT), DO2, and DO2/VO2 ratio during cardiopulmonary bypass (CPB) were significantly higher, while the need for CRRT and the 90-day mortality were significantly lower in the normoxic group. The median follow-up time was 4 months. Kaplan-Meier curve indicated that the survival rate of ATAAD patients in the normoxic group was significantly higher. Univariate cox regression analysis demonstrated that 90-day mortality was reduced by 72.1% in the normoxic group. Conclusions: Maintaining DO2 ≥280 mL/(min·m2) during CPB by increasing CPB flow and HCT level is associated with decreased 90-day mortality of ATAAD patients.
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Peng et al. (2023) conducted a cohort in Acute type A aortic dissection (ATAAD) (n=178). Intraoperative oxygen delivery (DO2) ≥280 mL/(min·m2) vs. DO2 <280 mL/(min·m2) was evaluated on 90-day all-cause mortality (72.1% reduction). Maintaining intraoperative oxygen delivery ≥280 mL/(min·m2) during cardiopulmonary bypass was associated with a 72.1% reduction in 90-day mortality in acute type A aortic dissection patients.
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