The effect of postoperative anticoagulation on false lumen patency after surgery for acute type A aortic dissection
(2021) In Journal of Cardiothoracic Surgery 16(1).- Abstract
Background: Patent false lumen has been shown to have a negative impact on prognosis after surgery for acute type A aortic dissection (ATAAD). We aimed to assess the effect of postoperative anticoagulation on false lumen patency and clinical outcomes in relation to false lumen status. Methods: Postoperative computed tomographies of 156 patients undergoing ATAAD DeBakey type I surgery were retrospectively evaluated for false lumen patency. The patients were divided into groups determined by anticoagulation treatment at discharge. Uni- and multivariable logistic regression was used for analysing the effect of anticoagulation on the false lumen, and Kaplan–Meier estimates were used to assess the association of a patent false lumen with the... (More)
Background: Patent false lumen has been shown to have a negative impact on prognosis after surgery for acute type A aortic dissection (ATAAD). We aimed to assess the effect of postoperative anticoagulation on false lumen patency and clinical outcomes in relation to false lumen status. Methods: Postoperative computed tomographies of 156 patients undergoing ATAAD DeBakey type I surgery were retrospectively evaluated for false lumen patency. The patients were divided into groups determined by anticoagulation treatment at discharge. Uni- and multivariable logistic regression was used for analysing the effect of anticoagulation on the false lumen, and Kaplan–Meier estimates were used to assess the association of a patent false lumen with the incidence of reoperation and long-term survival. Results: A patent false lumen was present in 81% of the patients. Postoperative anticoagulants were not associated with a patent false lumen (p = 0.48) in univariable analysis. In multivariable analysis, both hemiarch replacement (OR 0.15, CI95% 0.05–0.49, p = 0.001) and the use of betablockers had a protective effect (OR 0.29, CI95% 0.10–0.85, p = 0.023). The Kaplan–Meier estimates for survival and the composite endpoint of survival and freedom from distal reintervention indicated no difference in outcome between patients in regard to anticoagulation treatment (survival p = 0.43, composite p = 0.82) or false lumen status (survival p = 0.21, composite p = 0.09). Conclusion: This study could not show negative effects from the postoperative use of anticoagulants on false lumen status, nor that false lumen patency was associated with poorer prognosis. A hemiarch procedure was shown to be associated with reduced risk of false lumen patency.
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- author
- Larsson, Mårten LU ; Bozovic, Gracijela LU ; Sjögren, Johan LU ; Zindovic, Igor LU ; Ragnarsson, Sigurdur LU and Nozohoor, Shahab LU
- organization
- publishing date
- 2021-12-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Anticoagulation, Aortic dissection, False lumen
- in
- Journal of Cardiothoracic Surgery
- volume
- 16
- issue
- 1
- article number
- 279
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85115831027
- pmid:34583738
- ISSN
- 1749-8090
- DOI
- 10.1186/s13019-021-01661-1
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2021, The Author(s).
- id
- 461f3a3b-5b96-4349-849f-278d0b88c7c0
- date added to LUP
- 2021-11-19 09:48:08
- date last changed
- 2024-09-22 05:41:51
@article{461f3a3b-5b96-4349-849f-278d0b88c7c0,
abstract = {{<p>Background: Patent false lumen has been shown to have a negative impact on prognosis after surgery for acute type A aortic dissection (ATAAD). We aimed to assess the effect of postoperative anticoagulation on false lumen patency and clinical outcomes in relation to false lumen status. Methods: Postoperative computed tomographies of 156 patients undergoing ATAAD DeBakey type I surgery were retrospectively evaluated for false lumen patency. The patients were divided into groups determined by anticoagulation treatment at discharge. Uni- and multivariable logistic regression was used for analysing the effect of anticoagulation on the false lumen, and Kaplan–Meier estimates were used to assess the association of a patent false lumen with the incidence of reoperation and long-term survival. Results: A patent false lumen was present in 81% of the patients. Postoperative anticoagulants were not associated with a patent false lumen (p = 0.48) in univariable analysis. In multivariable analysis, both hemiarch replacement (OR 0.15, CI95% 0.05–0.49, p = 0.001) and the use of betablockers had a protective effect (OR 0.29, CI95% 0.10–0.85, p = 0.023). The Kaplan–Meier estimates for survival and the composite endpoint of survival and freedom from distal reintervention indicated no difference in outcome between patients in regard to anticoagulation treatment (survival p = 0.43, composite p = 0.82) or false lumen status (survival p = 0.21, composite p = 0.09). Conclusion: This study could not show negative effects from the postoperative use of anticoagulants on false lumen status, nor that false lumen patency was associated with poorer prognosis. A hemiarch procedure was shown to be associated with reduced risk of false lumen patency.</p>}},
author = {{Larsson, Mårten and Bozovic, Gracijela and Sjögren, Johan and Zindovic, Igor and Ragnarsson, Sigurdur and Nozohoor, Shahab}},
issn = {{1749-8090}},
keywords = {{Anticoagulation; Aortic dissection; False lumen}},
language = {{eng}},
month = {{12}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{Journal of Cardiothoracic Surgery}},
title = {{The effect of postoperative anticoagulation on false lumen patency after surgery for acute type A aortic dissection}},
url = {{http://dx.doi.org/10.1186/s13019-021-01661-1}},
doi = {{10.1186/s13019-021-01661-1}},
volume = {{16}},
year = {{2021}},
}