Clinical Study On Risk Factors And Outcomes Of Severe Systemic Inflammatory Response Syndrome After Total Aortic Arch Replacement Under Deep Hypothermic Circulatory Arrest

Objective:This study cohort aims to retrospectively investigate the incidence of severe systemic inflammatory response syndrome(sSIRS)in patients following total aortic arch replacement(TAR)under deep hypothermic circulatory arrest(DHCA)with selective cerebral perfusion and its effect on clinical outcomes.Methods:The entire patient charts who underwent TAR with DHCA were consecutively enrolled from January 2013 till December 2015 at our institute.The sSIRS was diagnosed between 12 and 48 post-operative hours as patients met all four criteria of the SIRS definition.Results:Of the 522 patients following TAR with DHCA,31.4%developed sSIRS.Patients aged under 60 yr were characterized by higher prevalence of sSIRS(OR=2.93;95%Cl 2.01-4.28;P<0.001).Higher baseline serum creatinine(OR=1.61;95%Cl 1.18-2.20;P=0.003),concomitant coronary disease(OR=2.00;95%Cl 1.15-3.48;P=0.015)as well as extended cardiopulmonary time(OR=l.63;95%Cl 1.23-2.18;P=0.001)could independently contribute to greater possibility of post-operative sSIRS onset,while the preferred administration of ulinastatin(OR=0.69;95%Cl 0.51-0.93;P=0.015)and dexmedetomidine(OR=0.36;95%Cl 0.23-0.56;P<0.001)can attenuate it.Patients with sSIRS had greater risk of developing postoperative major adverse complication compared with the no sSIRS group[56.7%(93/164)vs 26.8%(96/358),P<0.001].The sSIRS was found to be a significant risk factor for major adverse complication(OR,4.52;95%CI,3.40-6.01;P<0.001).The significant difference was revealed in in-hospital death following TAR between the sSIRS group and the no sSIRS group[4.88%(8/164)vs 1.12%(4/358),P=0.019].The Kaplan-Meier curve indicated the time of the discharge from intensive care unit was significantly prolonged in the sSIRS group compared with patients without it(log-rank p<0.001).Conclusions:sSIRS occurs commonly in patients following TAR with DHCA.There is an inverse association between age and sSIRS onset,whereby advancing age over 60 yr can lower the risk of it.The sSIRS development can increase the likelihood of postoperative major adverse event.