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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; Gudbjartsson, Tomas; Nozohoor, Shahab.
Afiliación
  • Zindovic I; Department of Cardiothoracic Surgery, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden. Electronic address: igor.zindovic@med.lu.se.
  • Sjögren J; Department of Cardiothoracic Surgery, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
  • Ahlsson A; Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital and School of Health and Medicine, Orebro University, Orebro, Sweden.
  • Bjursten H; Department of Cardiothoracic Surgery, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
  • Fuglsang S; Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark.
  • Geirsson A; Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
  • Ingemansson R; Department of Cardiothoracic Surgery, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
  • Hansson EC; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  • Mennander A; Heart Center Tampere University Hospital, Tampere, Finland.
  • Olsson C; Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
  • Pan E; Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
  • Ullén S; Clinical Studies Sweden-Forum South, Lund, Sweden.
  • Gudbjartsson T; Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
  • Nozohoor S; Department of Cardiothoracic Surgery, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
J Thorac Cardiovasc Surg ; 154(6): 1852-1859.e2, 2017 12.
Article en En | MEDLINE | ID: mdl-28967418
BACKGROUND: Surgery for acute type A aortic dissection (ATAAD) is often complicated by excessive bleeding. Recombinant factor VIIa (rFVIIa) effectively treats refractory bleeding associated with ATAAD surgery; however, adverse effects of rFVIIa in these patients have not been fully assessed. Here we evaluated rFVIIa treatment in ATAAD surgery using the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database. METHODS: This was a multicenter, propensity score-matched, retrospective study. Information about rFVIIa use was available for 761 patients, of whom 171 were treated with rFVIIa. We successfully matched 120 patients treated with rFVIIa with 120 controls. Primary endpoints were in-hospital mortality, postoperative stroke, and renal replacement therapy (RRT). Survival data were presented using Kaplan-Meier estimates. RESULTS: Compared with controls, patients treated with rFVIIa received more transfusions of packed red blood cells (median, 9.0 U [4.0-17.0 U] vs 5.0 U [2.0-11.0 U]; P = .008), platelets (4.0 U [2.0-8.0 U] vs 2.0 U [1.0-4.4 U]; P <.001), and fresh frozen plasma (8.0 U [4.0-18.0 U] vs 5.5 U [2.0-10.3 U]; P = .01) underwent reexploration for bleeding more often (31.0% vs 16.8%; P = .014); and had greater 24-hour chest tube output (1500 L [835-2500 mL] vs 990 mL [520-1720 mL]). Treatment with rFVIIa was not associated with significantly increased rates of in-hospital mortality (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.34-1.55; P = .487), postoperative stroke (OR, 1.75; 95% CI, 0.82-3.91; P = .163), or RRT (OR, 1.18; 95% CI, 0.48-2.92; P = .839). CONCLUSIONS: 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma de la Aorta / Coagulantes / Factor VIIa / Hemorragia Posoperatoria / Implantación de Prótesis Vascular / Disección Aórtica Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma de la Aorta / Coagulantes / Factor VIIa / Hemorragia Posoperatoria / Implantación de Prótesis Vascular / Disección Aórtica Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos