Comentale Giuseppe, Palma Gaetano, Parisi Valentina, Simeone Silvio, Pucciarelli Gianluca, Manzo Rachele, Pilato Emanuele, Giordano Raffaele
Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery-University of Naples Federico II, 80131 Naples, Italy.
Department of Translational Medical Sciences-University of Naples Federico II, 80131 Naples, Italy.
Healthcare (Basel). 2020 Nov 3;8(4):455. doi: 10.3390/healthcare8040455.
: Redo operations and preoperative antiplatelet/anticoagulant therapy can significantly increase surgical risk in congenital heart surgery. This is a retrospective study on the impact of preoperative aspirin therapy on the outcome of Tetralogy of Redo Fallot patients undergoing right ventricle outflow tract (RVOT) conduit implantation. : Ten-years retrospective analysis of medical records was carried out. A total of 72 patients were divided into two groups: "Daily-on-ASA" group on daily therapy with aspirin (ASA) until 5 days from surgery and "No-Home-ASA" without it. Propensity match analysis was done in order to standardize the populations. Intraoperative and postoperative lengths were compared as well as the need for inotropic support. In addition, differences in blood transfusions and need for Fresh frozen plasma (FFP)/platelets (PLT) were analysed. : Intraoperative lengths were similar between the groups. Not statistically significative differences about postoperative time to extubation ( = 0.34), ICU Stay ( = 0.31) or in-hospital stay ( = 0.36) were found. Drain loss was higher in the "Daily-on-ASA" group (407.9 ± 96.7 mL vs. 349.5 ± 84.3 mL; = 0.03) as well as blood transfusions (372.7 ± 255.1 mL vs. 220.1 ± 130.3 mL, = 0.02) and PLT/FFP need (217.7 ± 132.1 mL vs. 118.7 ± 147.1 mL, = 0.01). No differences were found in postoperative complications or re-explorations for bleeding. : We found no advantages in surgical times and hospital stay comparing redo patients who stopped aspirin versus those that didn't take it in the last 6 months. However, our results suggest that redo patients undergoing RVOT conduit implantation who take daily aspirin are at higher risk of bleeding even if it is stopped 5 days before surgery.
再次手术以及术前抗血小板/抗凝治疗会显著增加先天性心脏病手术的风险。这是一项关于术前阿司匹林治疗对接受右心室流出道(RVOT)管道植入的法洛四联症再次手术患者结局影响的回顾性研究。
对病历进行了十年的回顾性分析。总共72例患者被分为两组:“每日服用阿司匹林”组,在术前5天每日接受阿司匹林(ASA)治疗;“术前未服用阿司匹林”组,则未接受该治疗。进行倾向匹配分析以标准化研究人群。比较了术中及术后时长以及使用血管活性药物支持的必要性。此外,还分析了输血差异以及新鲜冰冻血浆(FFP)/血小板(PLT)的需求。
两组的术中时长相似。在术后拔管时间(P = 0.34)、重症监护病房(ICU)住院时间(P = 0.31)或住院时间(P = 0.36)方面未发现具有统计学意义的差异。“每日服用阿司匹林”组的引流量更高(407.9 ± 96.7 mL对349.5 ± 84.3 mL;P = 0.03),输血情况(372.7 ± 255.1 mL对220.1 ± 130.3 mL,P = 0.02)以及PLT/FFP需求(217.7 ± 132.1 mL对118.7 ± 147.1 mL,P = 0.01)也是如此。术后并发症或因出血再次手术方面未发现差异。
我们发现,在手术时间和住院时间方面,对比过去6个月内停用阿司匹林的再次手术患者和未服用阿司匹林的患者,前者并无优势。然而,我们的研究结果表明,接受RVOT管道植入的再次手术患者即使在术前5天停用每日服用的阿司匹林,出血风险仍更高。