Advanced

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)
Please use this url to cite or link to this publication:
author
organization
publishing date
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
  • scopus:85018299856
  • wos:000404043800004
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
2018-01-07 12:04:24
@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 &lt;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 &lt; 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},
  keyword      = {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},
  volume       = {24},
  year         = {2017},
}