Recombinant factor VIIa use in acute type A aortic dissection repair: A multicenter propensity-score-matched report from the Nordic Consortium for Acute Type A Aortic Dissection

Zindovic, Igor; Sjögren, Johan; Ahlsson, Anders; Bjursten, Henrik; Fuglsang, Simon; Geirsson, Arnar; Ingemansson, Richard; Hansson, Emma C.; Mennander, Ari; Olsson, Christian; Pan, Emily; Ullén, Susann; Guðbjartsson, Tómas; Nozohoor, Shahab

doi:10.1016/j.jtcvs.2017.08.020

Cited by 16 publications

(24 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The disturbances of the coagulation system in combination with the poor quality of the dissected aorta contribute to 25% of patients having massive bleeding associated with ATAAD surgery [10,87]. In several studies, bleeding has been identified as an independent predictor of early and late mortality after surgery for ATAAD and accounts for 20% of in-hospital deaths [6,10,88]. The bleeding can also extend into the pericardium and cause tamponade that can aggrevate cardiac and hypovolemic shock (Figure 3(c)).…”

Section: Complicationsmentioning

confidence: 99%

“…For those who reach hospital alive, important prognostic factors for 30-day and late mortality are shown in Table 3. These include advanced age [49], cerebrovascular injury [24,86], malperfusion [6,24,94], acute kidney injury (AKI) [106][107][108], preoperative tamponade or shock [109] (unpublished NORCAAD data), and also surgical factors such as cannulation site, duration of the operation, CPB time, and extent of surgery. The existing literature often implicates the aforementioned non-surgical characteristics as prognostic factors for late mortality, but on the other hand age and the comorbidity burden of the patients (mainly atherosclerosis) is also important for longterm survival in contemporary single-centre and multicentre series.…”

Section: Outcome and Long-term Follow-upmentioning

confidence: 99%

“…Thus, contemporary, sizeable, multicenter observational registries, of which NORCAAD is an example, stand out as important sources of information. This review covers different aspects of ATAAD, including epidemiology, pathophysiology, and surgical treatment, and concentrates especially on the NORCAAD studies that have been published so far [6][7][8][9][10][11][12][13]. We searched the PubMed and MEDLINE databases using the search terms "dissection," "aortic," "ascending," and "type A."…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

Self Cite

View full text Add to dashboard Cite

Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate. ARTICLE HISTORY Definitions and classification systemsDissection of the aorta occurs when the aortic media is separated, usually by pulsatile flow that penetrates the intimal layer of the aortic wall [14] (Figure 1(b)). This allows blood to flow between the layers of the aortic wall, forcing the layers apart, creating a false lumen parallel to the native (i.e. true) aortic lumen (Figure 1(b)). Consequently, the false lumen can propagate in both directions from the tear of intima and affect most of its distal branches, including the coronary, cerebral, and mesenteric arteries [15]. Another-but less common-CONTACT Tomas Gudbjartsson

show abstract

Section: Complicationsmentioning

confidence: 99%

Section: Outcome and Long-term Follow-upmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

Self Cite

View full text Add to dashboard Cite

show abstract

“…Concomitant procedures, such as coronary artery bypass grafting, were performed as indicated. Different procedural aspects of the NORCAAD registry have been published previously [8][9][10].…”

Section: Surgical Proceduresmentioning

confidence: 99%

Is There a Weekend Effect in Surgery for Type A Dissection?: Results From the Nordic Consortium for Acute Type A Aortic Dissection Database

Ahlsson

Wickbom

Geirsson

et al. 2019

The Annals of Thoracic Surgery

Self Cite

View full text Add to dashboard Cite

Background. Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated on during weekends have higher mortality rates compared with patients whose operations occur on weekdays. The weekend effect in aortic dissection type A has not been studied in detail.Methods. The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes data for 1,159 patients who underwent type A dissection surgery at 8 Nordic centers during 2005 to 2014. This study is based on data relating to surgery conducted during weekdays versus weekends and starting between 8:00 AM and 8:00 PM ("daytime") versus from 8:00 PM to 8:00 AM ("nighttime"), as well as time from symptoms, admittance, and diagnosis to surgery. The influence of timing of surgery on the 30-day mortality rate was assessed using logistic regression analysis.Results. The 30-day mortality was 18% (204 of 1,159), with no difference in mortality between surgery performed on weekdays (17% [150 of 889]) and on weekends (20% [54 of 270], p [ 0.45), or during nighttime (19% [87 of 467]) versus daytime (17% [117 of 680], p [ 0.54). Time from symptoms to surgery (median 7.0 hours vs 6.5 hours, p [ 0.31) did not differ between patients who survived and those who died at 30 days. Multivariable regression analysis of risk factors for 30-day mortality showed no weekend effect (odds ratio, 1.04; 95% confidence interval, 60.67 to 1.60; p [ 0.875), but nighttime surgery was a risk factor (odds ratio, 2.43; 95% confidence interval, 1.29 to 4.56; p [ 0.006).Conclusions. The 30-day mortality in surgical repair of aortic dissection type A was not significantly affected by timing of surgery during weekends versus weekdays. Nighttime surgery seems to predict increased 30-day mortality, after correction for other risk factors.

show abstract

“…Acute chest pain was sometimes diagnosed with acute coronary syndrome(ACS) [14]. The diagnosis of ACS requires electrocardiogram and cardiac markers.…”

Section: Commentmentioning

confidence: 99%

Outcomes of Preoperative Antiplatelet Therapy in Patients with Acute Type A Aortic Dissection

Jiang¹,

Shi²,

Fan³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Acute type A aortic dissection(ATAAD) is life-threatening and requires immediate surgery. Sudden chest pain may lead to a risk of misdiagnosis as acute coronary syndrome and may lead to subsequent antiplatelet therapy. We used the Chinese Acute Aortic Syndrome Collaboration Database (AAS) to study the effects of antiplatelet therapy (APT) on clinical outcomes. Methods: The AAS database is a retrospective multicentre database where 31 of 3092 had APT with aspirin or clopidogrel or both before surgery. Before and after propensity score matching, the incidence of complications and mortality was compared between APT and non-APT patients by using a logistic regression model. The sample remaining after PSM was 30 in the APT group and 80 in the non-APT group. Results: The sample remaining after matching was 30 in the APT group and 80 in the non-APT group. We found 10 cases with percutaneous coronary intervention in the APT group(33.3%). The APT group received more volume of packed red blood cell (RBC), 8.4±6.05 units; plasma, 401.67±727 ml, and platelet transfusion(14.07±8.92 units). The drainage volume was much more in the APT group( 5009.37±2131.44ml, P=0.004). Mortality was higher in APT group(26% vs 10%, P=0.027). The preoperative APT was independent predictor of mortality(OR 6.808, 95% CI1.554-29.828, P = 0.011). Conclusion: APT prior to ATAAD repair was associated with more transfusions and higher early mortality. The timing of surgery should be carefully considered based on the patient’s status and the surgeon’s experience.

show abstract

Recombinant factor VIIa use in acute type A aortic dissection repair: A multicenter propensity-score-matched report from the Nordic Consortium for Acute Type A Aortic Dissection

Abstract: In this propensity-matched cohort study of patients undergoing ATAAD surgery, treatment with rFVIIa for major bleeding was not associated with a significantly increased risk of stroke, RRT, or mortality.

Cited by 16 publications

References 19 publications

Acute type A aortic dissection – a review

Acute type A aortic dissection – a review

Is There a Weekend Effect in Surgery for Type A Dissection?: Results From the Nordic Consortium for Acute Type A Aortic Dissection Database

Outcomes of Preoperative Antiplatelet Therapy in Patients with Acute Type A Aortic Dissection

Contact Info

Product

Resources

About