Analysis of preoperative risk factors for prolonged mechanical ventilation after pulmonary thromboendarterectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xiaohui ^1,2 , LIU Zhan ^1,2 , ZHANG Zhaohua ^1,2 , ZHEN Yanan ² , LIN Fan ² , ZHENG Xia ² , LIU Xiaopeng ² , SUN Guang ² , WEN Jianyan ^1,2 , YE Zhidong ^1,2 ,  LIU Peng ^1,2

1. Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, P. R. China;
2. Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, 100029, P. R. China;

Corresponding author：

LIU Peng, Email: liupeng5417@163.com

Keywords：

Pulmonary thromboendarectomy; mechanical ventilation; risk factors

DOI：

10.7507/1007-4848.202111072

Video：

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Objective To identify the preoperative risk factors for prolonged mechanical ventilation (PMV) after pulmonary thromboendarterectomy (PTE). Methods The clinical data of patients who underwent PTE from December 2016 to August 2021 in our hospital were retrospectively analyzed. The patients were divided into two groups according to the postoperative mechanical ventilation time, including a postoperative mechanical ventilation time≤48 h group (≤48 h group) and a postoperative mechanical ventilation time>48 h (PMV) group (>48 h group). Univariable and logistic regression analysis were used to identify the preoperative risk factors for postoperative PMV. Results Totally, 90 patients were enrolled in this study. There were 40 patients in the ≤48 h group, including 30 males and 10 females, with a mean age of 45.48±12.72 years, and there were 50 patients in the >48 h group, including 29 males and 21 females, with a mean age of 55.50±10.42 years. The results showed that in the ≤48 h group, the median postoperative ICU stay was 3.0 days, and the median postoperative hospital stay was 15.0 days; in the >48 h group, the median postoperative ICU stay was 7.0 days, and the median postoperative hospital stay was 20.0 days. The postoperative PMV was significantly correlated with tricuspid annular plane systolic excursion (TAPSE) [OR=0.839, 95%CI (0.716, 0.983), P=0.030], age [OR=1.082, 95%CI (1.034, 1.132), P=0.001] and pulmonary vascular resistance (PVR) [OR=1.001, 95%CI (1.000, 1.003), P=0.028]. Conclusion Age and PVR are the preoperative risk factors for PMV after PTE, and TAPSE is the preoperative protective factor for PMV after PTE.

Citation： WANG Xiaohui, LIU Zhan, ZHANG Zhaohua, ZHEN Yanan, LIN Fan, ZHENG Xia, LIU Xiaopeng, SUN Guang, WEN Jianyan, YE Zhidong, LIU Peng. Analysis of preoperative risk factors for prolonged mechanical ventilation after pulmonary thromboendarterectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1452-1457. doi: 10.7507/1007-4848.202111072 Copy

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2.	Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
3.	Mullin CJ, Klinger JR. Chronic thromboembolic pulmonary hypertension. Heart Fail Clin. 2018, 14(3): 339-351.
4.	Delcroix M, Torbicki A, Gopalan D, et al. ERS statement on chronic thromboembolic pulmonary hypertension. Eur Respir J, 2021, 57(6): 2002828.
5.	Jenkins D, Madani M, Fadel E, et al. Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension. Eur Respir Rev, 2017, 26(143): 160111.
6.	Delcroix M, Lang I, Pepke-Zaba J, et al. Long-term outcome of patients with chronic thromboembolic pulmonary hypertension: Results from an international prospective registry. Circulation, 2016, 133(9): 859-871.
7.	Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, et al. Prolonged mechanical ventilation as a predictor of mortality after cardiac surgery. Respir Care, 2018, 63(5): 550-557.
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9.	Yan L, Li X, Liu Z, et al. Research progress on the pathogenesis of CTEPH. Heart Fail Rev, 2019, 24(6): 1031-1040.
10.	Kunieda T, Nakanishi N, Satoh T, et al. Prognoses of primary pulmonary hypertension and chronic majorvessel thromboembolic pulmonary hypertension determined from cumulative survival curves. Intern Med, 1999, 38(7): 543-546.
11.	Rubens FD, Bourke M, Hynes M, et al. Surgery for chronic thromboembolic pulmonary hypertension: Inclusive experience from a national referral center. Ann Thorac Surg, 2007, 83(3): 1075-1081.
12.	Jenkins D. Pulmonary endarterectomy: The potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension. Eur Respir Rev, 2015, 24(136): 263-271.
13.	刘晓鹏, 甄雅南, 孙光, 等. 深低温停循环技术在肺动脉血栓内膜剥脱手术中的应用. 中国医药科学, 2021, 11(15): 35-38.
14.	Bissett B, Gosselink R, van Haren FMP. Respiratory muscle rehabilitation in patients with prolonged mechanical ventilation: A targeted approach. Crit Care, 2020, 24(1): 103.
15.	Goligher EC, Dres M, Fan E, et al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med. 2018, 197(2): 204-213.
16.	Kunihara T, Gerdts J, Groesdonk H, et al. Predictors of postoperative outcome after pulmonary endarterectomy from a 14-year experience with 279 patients. Eur J Cardiothorac Surg. 2011, 40(1): 154-161.
17.	Li Y, Liu C, Xiao W, et al. Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: A meta-analysis. Neurocrit Care, 2020, 32(1): 272-285.
18.	Mayer E, Jenkins D, Lindner J, et al. Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: Results from an international prospective registry. J Thorac Cardiovasc Surg, 2011, 141(3): 702-710.
19.	Aloia E, Cameli M, D'Ascenzi F, et al. TAPSE: An old but useful tool in different diseases. Int J Cardiol, 2016, 225: 177-183.
20.	Floccari F, Granata A, Rivera R, et al. Echocardiography and right ventricular function in NKF stageⅢcronic kidney disease: Ultrasound nephrologists' role. J Ultrasound, 2012, 15(4): 252-256.
21.	Grabysa R, Wańkowicz Z. Can echocardiography, especially tricuspid annular plane systolic excursion measurement, predict pulmonary hypertension and improve prognosis in patients on long-term dialysis? Med Sci Monit, 2015, 21: 4015-4022.
22.	Di Lullo L, Floccari F, Polito P. Right ventricular diastolic function in dialysis patients could be affected by vascular access. Nephron Clin Pract, 2011, 118(3): c257-c261.
23.	Pariaut R, Saelinger C, Strickland KN, et al. Tricuspid annular plane systolic excursion (TAPSE) in dogs: Reference values and impact of pulmonary hypertension. J Vet Intern Med, 2012, 26(5): 1148-1154.
24.	Fedullo P, Kerr KM, Kim NH, et al. Chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med, 2011, 183(12): 1605-1613.
25.	Hsieh WC, Jansa P, Huang WC, et al. Residual pulmonary hypertension after pulmonary endarterectomy: A meta-analysis. J Thorac Cardiovasc Surg, 2018, 156(3): 1275-1287.
26.	Jančauskaitė D, Rudienė V, Jakutis G, et al. Residual pulmonary hypertension more than 20 years after repair of shunt lesions. Medicina (Kaunas), 2020, 56(6): 297.
27.	Galiè N, Kim NH. Pulmonary microvascular disease in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc, 2006, 3(7): 571-576.

1. Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J, 2019, 53(1): 1801913.
2. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
3. Mullin CJ, Klinger JR. Chronic thromboembolic pulmonary hypertension. Heart Fail Clin. 2018, 14(3): 339-351.
4. Delcroix M, Torbicki A, Gopalan D, et al. ERS statement on chronic thromboembolic pulmonary hypertension. Eur Respir J, 2021, 57(6): 2002828.
5. Jenkins D, Madani M, Fadel E, et al. Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension. Eur Respir Rev, 2017, 26(143): 160111.
6. Delcroix M, Lang I, Pepke-Zaba J, et al. Long-term outcome of patients with chronic thromboembolic pulmonary hypertension: Results from an international prospective registry. Circulation, 2016, 133(9): 859-871.
7. Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, et al. Prolonged mechanical ventilation as a predictor of mortality after cardiac surgery. Respir Care, 2018, 63(5): 550-557.
8. Stein E, Ramakrishna H, Augoustides JG. Recent advances in chronic thromboembolic pulmonary hypertension. J Cardiothorac Vasc Anesth, 2011, 25(4): 744-748.
9. Yan L, Li X, Liu Z, et al. Research progress on the pathogenesis of CTEPH. Heart Fail Rev, 2019, 24(6): 1031-1040.
10. Kunieda T, Nakanishi N, Satoh T, et al. Prognoses of primary pulmonary hypertension and chronic majorvessel thromboembolic pulmonary hypertension determined from cumulative survival curves. Intern Med, 1999, 38(7): 543-546.
11. Rubens FD, Bourke M, Hynes M, et al. Surgery for chronic thromboembolic pulmonary hypertension: Inclusive experience from a national referral center. Ann Thorac Surg, 2007, 83(3): 1075-1081.
12. Jenkins D. Pulmonary endarterectomy: The potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension. Eur Respir Rev, 2015, 24(136): 263-271.
13. 刘晓鹏, 甄雅南, 孙光, 等. 深低温停循环技术在肺动脉血栓内膜剥脱手术中的应用. 中国医药科学, 2021, 11(15): 35-38.
14. Bissett B, Gosselink R, van Haren FMP. Respiratory muscle rehabilitation in patients with prolonged mechanical ventilation: A targeted approach. Crit Care, 2020, 24(1): 103.
15. Goligher EC, Dres M, Fan E, et al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med. 2018, 197(2): 204-213.
16. Kunihara T, Gerdts J, Groesdonk H, et al. Predictors of postoperative outcome after pulmonary endarterectomy from a 14-year experience with 279 patients. Eur J Cardiothorac Surg. 2011, 40(1): 154-161.
17. Li Y, Liu C, Xiao W, et al. Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: A meta-analysis. Neurocrit Care, 2020, 32(1): 272-285.
18. Mayer E, Jenkins D, Lindner J, et al. Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: Results from an international prospective registry. J Thorac Cardiovasc Surg, 2011, 141(3): 702-710.
19. Aloia E, Cameli M, D'Ascenzi F, et al. TAPSE: An old but useful tool in different diseases. Int J Cardiol, 2016, 225: 177-183.
20. Floccari F, Granata A, Rivera R, et al. Echocardiography and right ventricular function in NKF stageⅢcronic kidney disease: Ultrasound nephrologists' role. J Ultrasound, 2012, 15(4): 252-256.
21. Grabysa R, Wańkowicz Z. Can echocardiography, especially tricuspid annular plane systolic excursion measurement, predict pulmonary hypertension and improve prognosis in patients on long-term dialysis? Med Sci Monit, 2015, 21: 4015-4022.
22. Di Lullo L, Floccari F, Polito P. Right ventricular diastolic function in dialysis patients could be affected by vascular access. Nephron Clin Pract, 2011, 118(3): c257-c261.
23. Pariaut R, Saelinger C, Strickland KN, et al. Tricuspid annular plane systolic excursion (TAPSE) in dogs: Reference values and impact of pulmonary hypertension. J Vet Intern Med, 2012, 26(5): 1148-1154.
24. Fedullo P, Kerr KM, Kim NH, et al. Chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med, 2011, 183(12): 1605-1613.
25. Hsieh WC, Jansa P, Huang WC, et al. Residual pulmonary hypertension after pulmonary endarterectomy: A meta-analysis. J Thorac Cardiovasc Surg, 2018, 156(3): 1275-1287.
26. Jančauskaitė D, Rudienė V, Jakutis G, et al. Residual pulmonary hypertension more than 20 years after repair of shunt lesions. Medicina (Kaunas), 2020, 56(6): 297.
27. Galiè N, Kim NH. Pulmonary microvascular disease in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc, 2006, 3(7): 571-576.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of preoperative risk factors for prolonged mechanical ventilation after pulmonary thromboendarterectomy

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