P355. Transfusion and Coagulation Management in Acute Type A Aortic Dissection
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Mainz
Germany - Contact Me
Philipp Pfeiffer, MD
Resident Physician Cardiac Surgery, Department of Cardivascular Surgery, University Medical Center Mainz, Germany
Education: Heidelberg University, Germany, Graduation (state examination): May 2020
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Acute type A aortic dissection (AAD) and the necessary surgical repair lead to a disruption of the physiological coagulation systems. Ensuring hemostasis is crucial, and routinely requires perioperative transfusions and substitution of coagulation factors. This retrospective study investigates the impact of various factors on the use of these products.
Methods: Patients operated for AAD between 2017 and 2022 were identified and demographics, comorbidities, clinical details, including the status at presentation and perioperative transfusions and administered coagulation factors, and postoperative details were obtained and stratified according to the Penn classification. 369 patients were included, consisting of 281 (76%) patients with DeBakey type I dissection and 88 (24%) patients with DeBakey type II dissection. Mean age was 65.5±13.1 years and 235 (64%) patients were male. Multivariable linear regression models for transfusions and coagulation factors were calculated including the variables age, gender, body-surface-are (BSA), preoperative oral anticoagulation, Penn classification, cardiopulmonary bypass (CPB) and distal ischemia times, lowest body temperature, and extent of surgery.
Results: The study collective, including comorbidities, prevalence of risk factors, and postoperative complications, is representative of AAD patients. Patients with preoperative shock and/or malperfusion required significantly more transfusions, prothrombin complex concentrates, and Fibrinogen both intraoperatively and in the early postoperative course (p≤0.007). Multivariable linear regression analysis revealed that shock, the duration of cardiopulmonary bypass, root replacement, the patient's size, and the preoperative use of oral anticoagulation were significant factors, while the other tested variables did not have a significant influence on transfusions and coagulation factor substitution.
Conclusions: Surgical repair for AAD remains major surgery requiring transfusions and coagulation factors in almost all patients. Significant factors that necessitate use of these products are shock, duration of CPB, and patient's size. With proper management, acceptable rethoracotomy and chest drain rates can be achieved with good clinical outcomes.
Authors
Philipp Pfeiffer (1), Vanessa Buchholz (1), Chris Probst (1), Ahmed Ghazy (1), Hendrik Treede (1), Daniel-Sebastian Dohle (1)
Institutions
(1) Univercity Medical Center Mainz, Mainz, Germany
Methods: Patients operated for AAD between 2017 and 2022 were identified and demographics, comorbidities, clinical details, including the status at presentation and perioperative transfusions and administered coagulation factors, and postoperative details were obtained and stratified according to the Penn classification. 369 patients were included, consisting of 281 (76%) patients with DeBakey type I dissection and 88 (24%) patients with DeBakey type II dissection. Mean age was 65.5±13.1 years and 235 (64%) patients were male. Multivariable linear regression models for transfusions and coagulation factors were calculated including the variables age, gender, body-surface-are (BSA), preoperative oral anticoagulation, Penn classification, cardiopulmonary bypass (CPB) and distal ischemia times, lowest body temperature, and extent of surgery.
Results: The study collective, including comorbidities, prevalence of risk factors, and postoperative complications, is representative of AAD patients. Patients with preoperative shock and/or malperfusion required significantly more transfusions, prothrombin complex concentrates, and Fibrinogen both intraoperatively and in the early postoperative course (p≤0.007). Multivariable linear regression analysis revealed that shock, the duration of cardiopulmonary bypass, root replacement, the patient's size, and the preoperative use of oral anticoagulation were significant factors, while the other tested variables did not have a significant influence on transfusions and coagulation factor substitution.
Conclusions: Surgical repair for AAD remains major surgery requiring transfusions and coagulation factors in almost all patients. Significant factors that necessitate use of these products are shock, duration of CPB, and patient's size. With proper management, acceptable rethoracotomy and chest drain rates can be achieved with good clinical outcomes.
Authors
Philipp Pfeiffer (1), Vanessa Buchholz (1), Chris Probst (1), Ahmed Ghazy (1), Hendrik Treede (1), Daniel-Sebastian Dohle (1)
Institutions
(1) Univercity Medical Center Mainz, Mainz, Germany
Presentation Duration
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