Predictors and impact of massive bleeding in acute type A aortic dissection
Zindovic, Igor LU ; Sjogren, Johan LU ; Bjursten, Henrik LU ; Björklund, Erik ; Herou, Erik LU
; Ingemansson, Richard
LU
and Nozohoor, Shahab
LU
(2017)
In Interactive Cardiovascular and Thoracic Surgery
24(4).
p.498-505
- Abstract
OBJECTIVES: Bleeding complications associated with acute type A aortic dissection (aTAAD) are a well-known clinical problem. Here, we evaluated predictors of massive bleeding related to aTAAD and associated surgery and assessed the impact of massive bleeding on complications and survival. METHODS: This retrospective study of 256 patients used Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART) criteria to define massive bleeding, which was met by 66 individuals (Group I) who were compared to the remaining patients (Group II). Multivariable logistic regression was used to identify independent predictors of massive bleeding and in-hospital mortality, Kaplan-Meier estimates for analysis of late survival, and Cox... (More)
OBJECTIVES: Bleeding complications associated with acute type A aortic dissection (aTAAD) are a well-known clinical problem. Here, we evaluated predictors of massive bleeding related to aTAAD and associated surgery and assessed the impact of massive bleeding on complications and survival. METHODS: This retrospective study of 256 patients used Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART) criteria to define massive bleeding, which was met by 66 individuals (Group I) who were compared to the remaining patients (Group II). Multivariable logistic regression was used to identify independent predictors of massive bleeding and in-hospital mortality, Kaplan-Meier estimates for analysis of late survival, and Cox regression analysis to evaluate independent predictors of late mortality. RESULTS: Independent predictors of massive bleeding included symptom duration (odds ratio [OR], 0.974 per hour increment; 95% confidence interval [CI], 0.950-0.999; P = 0.041) and DeBakey type 1 dissection (OR, 2.652; 95% CI, 1.004-7.008; P = 0.049). In-hospital mortality was higher in Group I (30.3% vs 8.0%, P <0.001). Kaplan-Meier estimates of survival indicated poorer survival for Group I at 1, 3 and 5 years (68.8 ± 5.9% vs 92.8 ± 1.9%; 65.2 ± 6.2% vs 85.3 ± 2.7%; 53.9 ± 6.9% vs 82.1 ± 3.3 %, respectively; log rank P < 0.001). Re-exploration for bleeding was an independent predictor of in-hospital (OR, 3.109; 95% CI, 1.044-9.256; P = 0.042) and late mortalities (hazard ratio, 3.039; 95% CI, 1.605-5.757; P = 0.001). CONCLUSIONS: Massive bleeding in patients with aTAAD is prompted by shorter symptom duration and longer extent of dissection and has deleterious effects on outcomes of postoperative complications as well as in-hospital and late mortalities.
(Less)
- author
- Zindovic, Igor
LU
; Sjogren, Johan
LU
; Bjursten, Henrik
LU
; Björklund, Erik
; Herou, Erik
LU
; Ingemansson, Richard
LU
and Nozohoor, Shahab
LU
- organization
- publishing date
- 2017
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Aneurysm, Aorta, Dissecting, Haemorrhage, Reoperation
- in
- Interactive Cardiovascular and Thoracic Surgery
- volume
- 24
- issue
- 4
- pages
- 8 pages
- publisher
- European Association of Cardio-Thoracic Surgery
- external identifiers
-
- pmid:28093462
- wos:000404043800004
- scopus:85018299856
- ISSN
- 1569-9293
- DOI
- 10.1093/icvts/ivw425
- language
- English
- LU publication?
- yes
- id
- 89d48447-7182-4d11-8ee5-cb4c4dbadba8
- date added to LUP
- 2017-05-19 09:57:44
- date last changed
- 2025-01-07 13:49:18
@article{89d48447-7182-4d11-8ee5-cb4c4dbadba8,
abstract = {{<p>OBJECTIVES: Bleeding complications associated with acute type A aortic dissection (aTAAD) are a well-known clinical problem. Here, we evaluated predictors of massive bleeding related to aTAAD and associated surgery and assessed the impact of massive bleeding on complications and survival. METHODS: This retrospective study of 256 patients used Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART) criteria to define massive bleeding, which was met by 66 individuals (Group I) who were compared to the remaining patients (Group II). Multivariable logistic regression was used to identify independent predictors of massive bleeding and in-hospital mortality, Kaplan-Meier estimates for analysis of late survival, and Cox regression analysis to evaluate independent predictors of late mortality. RESULTS: Independent predictors of massive bleeding included symptom duration (odds ratio [OR], 0.974 per hour increment; 95% confidence interval [CI], 0.950-0.999; P = 0.041) and DeBakey type 1 dissection (OR, 2.652; 95% CI, 1.004-7.008; P = 0.049). In-hospital mortality was higher in Group I (30.3% vs 8.0%, P <0.001). Kaplan-Meier estimates of survival indicated poorer survival for Group I at 1, 3 and 5 years (68.8 ± 5.9% vs 92.8 ± 1.9%; 65.2 ± 6.2% vs 85.3 ± 2.7%; 53.9 ± 6.9% vs 82.1 ± 3.3 %, respectively; log rank P < 0.001). Re-exploration for bleeding was an independent predictor of in-hospital (OR, 3.109; 95% CI, 1.044-9.256; P = 0.042) and late mortalities (hazard ratio, 3.039; 95% CI, 1.605-5.757; P = 0.001). CONCLUSIONS: Massive bleeding in patients with aTAAD is prompted by shorter symptom duration and longer extent of dissection and has deleterious effects on outcomes of postoperative complications as well as in-hospital and late mortalities.</p>}},
author = {{Zindovic, Igor and Sjogren, Johan and Bjursten, Henrik and Björklund, Erik and Herou, Erik and Ingemansson, Richard and Nozohoor, Shahab}},
issn = {{1569-9293}},
keywords = {{Aneurysm; Aorta; Dissecting; Haemorrhage; Reoperation}},
language = {{eng}},
number = {{4}},
pages = {{498--505}},
publisher = {{European Association of Cardio-Thoracic Surgery}},
series = {{Interactive Cardiovascular and Thoracic Surgery}},
title = {{Predictors and impact of massive bleeding in acute type A aortic dissection}},
url = {{http://dx.doi.org/10.1093/icvts/ivw425}},
doi = {{10.1093/icvts/ivw425}},
volume = {{24}},
year = {{2017}},
}