Transfusion and coagulation management in acute type A aortic dissection

Abstract

Background: In acute type A dissection, the coagulation system is impaired by the dissection and its complications as well as the use of the heart-lung machine with hypothermia. Because of the critical importance of effective haemostasis at the end of the operation, the use of coagulation products and blood transfusions is usually unavoidable.

Aim: This retrospective study aims to analyse the use of blood products and coagulation factors in the context of acute aortic dissections, and the factors influencing their use.

Methods: Between 2017 and 2022, 369 patients were operated on for acute type A dissection. Clinical details, including the status at presentation and perioperatively administered transfusions and coagulation factors were obtained, and patients were stratified according to the Penn classification. A multivariable linear regression analysis for transfusions and coagulation factors was conducted, including typical risk factors.

Results: The use of perioperatively required transfusions and coagulation factor (prothrombin complex concentrate and fibrinogen) substitution increased significantly with a higher ischaemic burden, including both localized and generalized malperfusion (Penn A<B<C<BC; P≤0.017). Multivariable linear regression analysis revealed that, besides generalized ischaemia, duration of cardiopulmonary bypass, extent of surgery and patient size were other significant factors.

Conclusions: Surgical repair for acute type A dissection remains major surgery, requiring transfusions and coagulation factors in almost all patients. The ischaemic burden was identified as the most important factor that necessitates the use of these products, and was associated with early death. With proper management, acceptable rethoracotomy and chest drain rates with good clinical outcomes can be achieved.

Keywords: Aortic dissection; Aortic surgery; Coagulation factors; Transfusions.