Abstract：
Background. Surgery for acute type A aortic dissection confers a risk for significant bleeding. We analyzed the impact of massive bleeding on complications after surgery for acute type A aortic dissection. Methods. Patients undergoing surgery for acute type A aortic dissection from the retrospective multicenter Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database 2005-2014 were eligible. Massive bleeding was defined according to the Universal Definition of Perioperative Bleeding. The primary outcome measure was early mortality and secondary outcome measures were perioperative stroke, mechanical ventilation more than 48 h, new-onset dialysis, and intensive care unit stay. Propensity score matching was performed to adjust for differences in covariates. Results. Nine hundred ninety-seven patients were included, of whom 403 (40.4%) had massive bleeding. In the propensity score-matched cohort (344 pairs), patients with massive bleeding had higher 30-day mortality (17.2 versus 7.6%, p < .001), mechanical ventilation more than 48 h (52.8 versus 22.6%, p < .001), perioperative stroke (24.3 versus 14.8%, p = .002), new-onset dialysis (22.5 versus 4.9%, p < .001), and longer intensive care unit stay (6 versus 3 days, p < .001), compared with patients without massive bleeding. Risk factors for massive bleeding were previous cardiac surgery, preoperative clopidogrel or ticagrelor therapy, DeBakey type I dissection, and localized or generalized malperfusion. Conclusions. Massive bleeding in surgery for acute type A aortic dissection is associated with a markedly increased risk for severe complications as well as early death. Further improvement of surgical technique and pharmacological optimization of coagulation is paramount to possibly improve outcomes in acute type A aortic dissection repair.
摘要：
背景。急性A型主动脉夹层的手术赋予大量出血的风险。分析大出血对急性A型主动脉夹层术后并发症的影响。方法。从2005-2014年急性A型主动脉夹层回顾性多中心北欧联盟（NORCAAD）数据库中接受急性A型主动脉夹层手术的患者符合资格。根据围手术期出血的通用定义定义大量出血。主要结局指标是早期死亡率，次要结局指标是围手术期卒中，机械通气超过48小时，新的透析，和重症监护病房。进行倾向评分匹配以调整协变量的差异。结果。九百九十七名患者被包括在内，其中403人（40.4%）有大量出血。在倾向得分匹配的队列中(344对)，大出血患者30天死亡率较高(17.2%vs7.6%,p<.001),机械通气超过48小时(52.8对22.6%，p<.001),围手术期卒中（24.3对14.8%，p=.002)，新发透析（22.5对4.9%，p<.001),和更长时间的重症监护病房（6天和3天，p<.001),与无大出血的患者相比。大量出血的危险因素是以前的心脏手术，术前氯吡格雷或替格瑞洛治疗，DeBakeyI型解剖,局部或全身灌注不良。Conclusions.急性A型主动脉夹层手术中大量出血与严重并发症和早期死亡的风险明显增加有关。手术技术的进一步改进和凝血的药理学优化对于可能改善急性A型主动脉夹层修复的结果至关重要。
