Journal of multidisciplinary healthcare · 2024
Effects of Surgery on Hemodynamics and Postoperative Delirium in Stanford Type A Aortic Dissection.
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Urizar María Pilar, Gambra Enrique, de Castro Alberto, de la Peña Álvaro, Cetinkaya Onur, Marcos Susana, Curatolo Andrea
Аннотация
OBJECTIVE: To investigate the impact of surgical intervention on hemodynamic parameters and postoperative delirium in Stanford Type A aortic dissection patients.
METHODS: A retrospective analysis was conducted on 139 patients who underwent surgery for Stanford Type A aortic dissection from February 2022 to February 2024. Hemodynamic parameters, including maximum ascending aortic diameter (MAAD), left ventricular end-diastolic diameter (LVEDd), and ejection fraction (LVEF), were compared pre- and post-surgery. Patients were divided into two groups based on delirium occurrence postoperatively: Group A (n=49, with delirium) and Group B (n=90, without delirium). Differences in surgical factors and intensive care conditions were analyzed, and risk factors for postoperative delirium were identified. Group sizes differ due to retrospective categorization based on observed outcomes rather than controlled sampling.
RESULTS: ① Hemodynamic parameters: Postoperative MAAD and LVEDd were significantly reduced, while LVEF increased compared to preoperative levels (P < 0.05). ② Surgical and postoperative conditions: Group A had longer surgery, cardiopulmonary bypass, and deep hypothermic circulatory arrest times than Group B (P < 0.05). ③ Univariate analysis of baseline data: Group A had higher rates of patients aged ≥60, hypertension, history of stroke, and elevated preoperative D-dimer levels (P < 0.05). ④ Multivariate logistic analysis: Independent risk factors for postoperative delirium included age ≥60, hypertension, history of stroke, surgery time >6 hours, cardiopulmonary bypass time >3 hours, and deep hypothermic circulatory arrest time >40 minutes (OR > 1, P < 0.05).
CONCLUSION: Surgical treatment of Stanford Type A aortic dissection has a good effect, significantly improving long-term cardiac function. However, the incidence of postoperative delirium is relatively high and is closely related to factors such as age, hypertension, history of stroke, surgery time, cardiopulmonary bypass time, and deep hypothermic circulatory arrest time.
METHODS: A retrospective analysis was conducted on 139 patients who underwent surgery for Stanford Type A aortic dissection from February 2022 to February 2024. Hemodynamic parameters, including maximum ascending aortic diameter (MAAD), left ventricular end-diastolic diameter (LVEDd), and ejection fraction (LVEF), were compared pre- and post-surgery. Patients were divided into two groups based on delirium occurrence postoperatively: Group A (n=49, with delirium) and Group B (n=90, without delirium). Differences in surgical factors and intensive care conditions were analyzed, and risk factors for postoperative delirium were identified. Group sizes differ due to retrospective categorization based on observed outcomes rather than controlled sampling.
RESULTS: ① Hemodynamic parameters: Postoperative MAAD and LVEDd were significantly reduced, while LVEF increased compared to preoperative levels (P < 0.05). ② Surgical and postoperative conditions: Group A had longer surgery, cardiopulmonary bypass, and deep hypothermic circulatory arrest times than Group B (P < 0.05). ③ Univariate analysis of baseline data: Group A had higher rates of patients aged ≥60, hypertension, history of stroke, and elevated preoperative D-dimer levels (P < 0.05). ④ Multivariate logistic analysis: Independent risk factors for postoperative delirium included age ≥60, hypertension, history of stroke, surgery time >6 hours, cardiopulmonary bypass time >3 hours, and deep hypothermic circulatory arrest time >40 minutes (OR > 1, P < 0.05).
CONCLUSION: Surgical treatment of Stanford Type A aortic dissection has a good effect, significantly improving long-term cardiac function. However, the incidence of postoperative delirium is relatively high and is closely related to factors such as age, hypertension, history of stroke, surgery time, cardiopulmonary bypass time, and deep hypothermic circulatory arrest time.