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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Massive Bleeding After Surgical Repair in Acute Type A Aortic Dissection Patients: Risk Factors, Outcomes, and the
Chen-Han Zhang1, Yi-Peng Ge1, Yong-Liang Zhong1
1Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.
Frontiers in Cardiovascular Medicine
|July 28, 2022
Summary
Massive bleeding during aortic repair for acute type A aortic dissection (ATAAD) is linked to male sex, emergent surgery, and complex procedures. Identifying these risk factors aids in choosing appropriate surgical strategies to improve patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Diseases
Background:
- Massive bleeding is a severe complication during aortic repair in acute type A aortic dissection (ATAAD) patients.
- This complication can lead to significant clinical issues and increased mortality.
- Understanding risk factors and outcomes is crucial for managing ATAAD patients undergoing emergent aortic repair.
Purpose of the Study:
- To identify risk factors associated with massive bleeding in ATAAD patients undergoing emergent aortic repair.
- To evaluate the short-term outcomes of massive bleeding in these patients.
- To develop a predictive model for massive bleeding in ATAAD patients.
Main Methods:
- A retrospective study of 402 consecutive ATAAD patients who underwent emergent aortic repair.
- Massive bleeding defined using the universal definition of perioperative bleeding (UDPB) class 3 and 4.
- Multivariable regression and logistic regression analyses were used to identify risk factors and build a predictive model.
Main Results:
- Independent risk factors for massive bleeding include male sex, older age, low BMI, emergent surgery, prolonged cardiopulmonary bypass time, lower hemoglobin, elevated D-dimer and fibrin degradation products, and complex aortic arch repair (hemiarch or total arch replacement).
- Massive bleeding was associated with significantly higher early-stage mortality (15.9% vs. 3.9%).
- The developed predictive model demonstrated good discrimination (AUC = 0.817) and calibration.
Conclusions:
- Massive bleeding in ATAAD patients undergoing emergent repair is associated with specific demographic, clinical, and surgical factors.
- The identified risk factors, including gender, emergent surgery, elevated D-dimer, longer CPB time, anemia, and complex surgical strategies, highlight patient vulnerability.
- Given the higher mortality associated with massive bleeding, careful selection of surgical strategies is essential for high-risk patients.
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