Predictors of Prolonged Mechanical Ventilation After Aortic Arch Surgery With Deep Hypothermic Circulatory Arrest Plus Antegrade Selective Cerebral Perfusion

Objective: The predictors of prolonged mechanical ventilation after aortic arch surgery with deep hypothermic circulatory arrest have not been comprehensively evaluated. The present study was designed to identify variables associated with prolonged ventilation in a group of aortic arch surgery patients from a single center. Design: A retrospective study. Prolonged mechanical ventilation was defined as >72 hours. Setting: Cardiovascular operating rooms and the intensive care unit. Participants: Adults requiring aortic arch surgery with deep hypothermic circulatory arrest plus antegrade selective cerebral perfusion. Interventions: None. Measurements and Main Results: After 7 patients who underwent 1-stage total or subtotal aortic replacement were excluded, 255 patients were enrolled in the study. The average age of the patients was 44.7 +/- 10.8 years with male predominance (74.1%). Two hundred twenty-nine patients were extubated within 72 hours postoperatively, and 26 patients needed prolonged mechanical ventilation. Patients with prolonged mechanical ventilation had higher incidences of in-hospital mortality, stroke, and renal failure requiring dialysis and reintubation and stayed longer in the intensive care unit and hospital than those without prolonged ventilation (p < 0.05). In multivariate analysis, predictors of prolonged ventilation were found to be prolonged cardiopulmonary bypass time, advanced age, emergency, and preoperative serum creatinine level (p < 0.05). Conclusion: The authors identified 4 preoperative and intraoperative predictors associated with increased risk of prolonged mechanical ventilation. This is helpful to identify patients with increased risk for prolonged ventilation, develop preemptive strategies, and allocate medical resources. (C) 2009 Elsevier Inc. All rights reserved.