Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital/Northwell Health, Manhasset, New York, USA.
Department of Hematology and Oncology, Lenox Hill Hospital/Northwell Health, New York, New York, USA.
Transfusion. 2022 Nov;62(11):2235-2244. doi: 10.1111/trf.17117. Epub 2022 Sep 21.
Perioperative bleeding and transfusion have been associated with adverse outcomes after cardiac surgery. The use of factor eight inhibiting bypass activity (FEIBA) in managing bleeding after repair of acute Stanford type A aortic dissection (ATAAD) has not previously been evaluated. We report our experience in utilizing FEIBA in ATAAD repair.
A retrospective review was undertaken of all consecutive patients who underwent repair of ATAAD between July 2014 and December 2019. Patients were divided into two groups, dependent upon whether or not they received FEIBA intraoperatively: "FEIBA" (n = 112) versus "no FEIBA" (n = 119). From this, 53 propensity-matched pairs of patients were analyzed with respect to transfusion requirements and short-term clinical outcomes.
Thirty-day mortality for the entire cohort was 11.7% (27 deaths), not significantly different between patient groups. Those patients who received FEIBA demonstrated reduced transfusion requirements for all types of blood products in the first 48 h after surgery as compared with the "no FEIBA" cases, including red blood cells, platelets, plasma, and cryoprecipitate (p < .0001). There was no significant difference in major postoperative morbidity between the two groups. The FEIBA cohort did not demonstrate an increased incidence of thrombotic complications (stroke, deep venous thrombosis, pulmonary thromboembolism).
When used as rescue therapy for refractory bleeding following repair of ATAAD, FEIBA appears to be effective in decreasing postoperative transfusion requirements whilst not negatively impacting clinical outcomes. These findings should prompt further investigation and validation via larger, multi-center, randomized trials.
围手术期出血和输血与心脏手术后的不良结局有关。在修复急性斯坦福 A 型主动脉夹层（ATAAD）后，使用因子八抑制旁路活性（FEIBA）来控制出血的情况尚未得到评估。我们报告了在修复 ATAAD 中使用 FEIBA 的经验。
对 2014 年 7 月至 2019 年 12 月期间连续接受 ATAAD 修复的所有患者进行了回顾性分析。患者分为两组，取决于是否在术中使用 FEIBA：“FEIBA”（n=112）与“无 FEIBA”（n=119）。在此基础上，对 53 对具有可比性的患者进行了分析，比较了输血需求和短期临床结局。
整个队列的 30 天死亡率为 11.7%（27 例死亡），两组之间无显著差异。与“无 FEIBA”组相比，使用 FEIBA 的患者在手术后 48 小时内，所有类型的血液制品（包括红细胞、血小板、血浆和冷沉淀）的输血需求均减少（p<0.0001）。两组之间的主要术后发病率无显著差异。FEIBA 组未出现血栓并发症（中风、深静脉血栓形成、肺血栓栓塞症）的发生率增加。
当作为修复 ATAAD 后难治性出血的抢救治疗时，FEIBA 似乎可以有效减少术后输血需求，而不会对临床结局产生负面影响。这些发现应该促使进一步通过更大、多中心、随机试验进行调查和验证。
