Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Scand Cardiovasc J. 2024 Dec;58(1):2382477. doi: 10.1080/14017431.2024.2382477. Epub 2024 Aug 1.
. Surgery for acute type A aortic dissection confers a risk for significant bleeding. We analyzed the impact of massive bleeding on complications after surgery for acute type A aortic dissection. . Patients undergoing surgery for acute type A aortic dissection from the retrospective multicenter Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database 2005-2014 were eligible. Massive bleeding was defined according to the Universal Definition of Perioperative Bleeding. The primary outcome measure was early mortality and secondary outcome measures were perioperative stroke, mechanical ventilation more than 48 h, new-onset dialysis, and intensive care unit stay. Propensity score matching was performed to adjust for differences in covariates. . Nine hundred ninety-seven patients were included, of whom 403 (40.4%) had massive bleeding. In the propensity score-matched cohort (344 pairs), patients with massive bleeding had higher 30-day mortality (17.2 versus 7.6%, < .001), mechanical ventilation more than 48 h (52.8 versus 22.6%, < .001), perioperative stroke (24.3 versus 14.8%, = .002), new-onset dialysis (22.5 versus 4.9%, < .001), and longer intensive care unit stay (6 versus 3 days, < .001), compared with patients without massive bleeding. Risk factors for massive bleeding were previous cardiac surgery, preoperative clopidogrel or ticagrelor therapy, DeBakey type I dissection, and localized or generalized malperfusion. . Massive bleeding in surgery for acute type A aortic dissection is associated with a markedly increased risk for severe complications as well as early death. Further improvement of surgical technique and pharmacological optimization of coagulation is paramount to possibly improve outcomes in acute type A aortic dissection repair.
. 急性 A 型主动脉夹层的手术会带来大量出血的风险。我们分析了大量出血对急性 A 型主动脉夹层手术后并发症的影响。. 这项回顾性多中心北欧急性 A 型主动脉夹层协作研究（NORCAAD）数据库 2005 年至 2014 年期间接受急性 A 型主动脉夹层手术的患者符合入选条件。大量出血根据围手术期出血的通用定义来定义。主要观察终点为早期死亡率，次要观察终点为围手术期卒中、机械通气超过 48 小时、新发透析和重症监护病房（ICU）停留时间。采用倾向评分匹配来调整协变量的差异。. 共纳入 997 例患者，其中 403 例（40.4%）发生大量出血。在倾向评分匹配队列（344 对）中，大量出血患者的 30 天死亡率更高（17.2%比 7.6%， < .001）、机械通气时间超过 48 小时（52.8%比 22.6%， < .001）、围手术期卒中（24.3%比 14.8%， = .002）、新发透析（22.5%比 4.9%， < .001）和 ICU 停留时间更长（6 天比 3 天， < .001）。大量出血的危险因素包括既往心脏手术、术前氯吡格雷或替格瑞洛治疗、DeBakey Ⅰ型夹层以及局限性或广泛性灌注不良。. 急性 A 型主动脉夹层手术中的大量出血与严重并发症以及早期死亡的风险显著增加相关。进一步改进手术技术和优化凝血的药理学作用对于可能改善急性 A 型主动脉夹层修复的结果至关重要。
