Transfusion and coagulation management in acute type A aortic dissection.

Area of Science:

• Cardiovascular Surgery
• Hematology
• Aortic Disease

Background:

• Acute type A dissection impairs coagulation due to the condition and cardiopulmonary bypass with hypothermia.
• Effective hemostasis is critical post-surgery, often necessitating blood products and coagulation factors.

Purpose of the Study:

• To analyze blood product and coagulation factor use in acute type A dissection.
• To identify factors influencing the perioperative administration of these agents.

Main Methods:

• Retrospective analysis of 369 patients operated on for acute type A dissection (2017-2022).
• Stratification by Penn classification and multivariable linear regression analysis of transfusions and coagulation factors.
• Inclusion of clinical details, presentation status, and perioperative interventions.

Main Results:

• Transfusion and coagulation factor (prothrombin complex concentrate, fibrinogen) use increased with higher ischemic burden (localized and generalized malperfusion; Penn A
• Multivariable analysis identified generalized ischemia, cardiopulmonary bypass duration, surgical extent, and patient size as significant influencing factors.

Conclusions:

• Surgical repair of acute type A dissection is major surgery, almost always requiring transfusions and coagulation factors.
• Ischemic burden is the primary factor necessitating these products and is linked to early mortality.
• Appropriate management can lead to good clinical outcomes with acceptable rethoracotomy and chest drain rates.