The reduction of coagulation factor activity R before surgery increases the risk of postoperative neurological complications in patients with acute type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LANG Qun ¹ ,  LI Yijiang ¹ , PENG Hao ² , JIAN Kaitao ²

1. Department of Cardiovascular Surgery, Shenzhen Hospital, The Third School of Clinical Medicine, Southern Medical University, Shenzhen, 518000, Guangdong, P.R.China;
2. Department of Cardiovascular Surgery, Shanghai Delta Hospital, Shanghai, 201702, P.R.China;

Corresponding author：

LI Yijiang, Email: li.yijiang@hotmail.com

Keywords：

Stanford type A aortic dissection; neurological complications; emergency surgery; coagulation factor activity R

DOI：

10.7507/1007-4848.202006024

Video：

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Objective To analyze the risk factors for neurological complications after emergency surgery of acute type A aortic dissection.Methods The clinical data of 51 patients with acute Stanford type A aortic dissection who were admitted to Shanghai Delta Hospital from October 2018 to May 2019 were retrospectively analyzed. There were 37 males (72.5%) and 14 females (27.5%), aged 29-85 (55.1±12.3) years. The patients were divided into two groups, including a N1 group (n=12, patients with postoperative neurological insufficiency) and a N0 group (n=39, patients without postoperative neurological insufficiency). The clinical data of the two groups were compared and analyzed.Results There were statistical differences in age (62.6±11.2 years vs. 51.7±11.4 years, P=0.003), preoperative D-dimer (21.7±9.2 µg/L vs.10.8±10.7 µg/L, P=0.001), tracheal intubation time (78.7±104.0 min vs. 19.6±31.8 min, P=0.003), ICU stay time (204.1±154.8 min vs. 110.8±139.9 min, P=0.037) and preoperative coagulation factor activity R (4.0±1.5 vs. 5.1±1.6, P=0.022). Preoperative coagulation factor activity R was the independent risk factor for neurological insufficiency after emergency (OR=2.013, 95%CI 1.008-4.021, P=0.047).Conclusion For patients with pre-emergent acute aortic dissection who are older (over 62.6-64.5 years), with reduced coagulation factor R (less than 4.0), it is recommended to take more active brain protection measures to reduce the occurrence of postoperative neurological complications in patients with acute aortic dissection, and further improve the quality of life.

Citation： LANG Qun, LI Yijiang, PENG Hao, JIAN Kaitao. The reduction of coagulation factor activity R before surgery increases the risk of postoperative neurological complications in patients with acute type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(7): 792-795. doi: 10.7507/1007-4848.202006024 Copy

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8.	Svensson LG, Crawford ES, Hess KR, et al. Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg, 1993, 106(1): 19-28.
9.	李辉, 李娟, 王振东, 等. Stanford A 型主动脉夹层术后早期发生脑血管事件相关危险因素分析. 心肺血管病杂志, 2020, 39(1): 44-48.
10.	Smith A, Patterson C, Yarnell J, et al. Which hemostatic markers add to the predictive value of conventional risk factors for coronary heart disease and ischemic stroke? The Caerphilly Study. Circulation, 2005, 112(20): 3080-3087.
11.	王兆钺. D 二聚体临床应用的进展. 血栓与止血学, 2014, 20(1): 46-48.
12.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
13.	Vele E, Kurtcehajic A, Zerem E, et al. Plasma D-dimer as a predictor of the progression of abdominal aortic aneurysm. J Thromb Haemost, 2016, 14(11): 2298-2303.
14.	李明辉, 时露. 血栓和出血性疾病中血栓弹力图与常规凝血功能检测指标的相关性分析. 现代医药卫生, 2016, 32(17): 2703-2704.
15.	范焕青, 张金涛. 青年脑梗死发病的相关危险因素研究进展. 实用医药杂志, 2010, 27(3): 266-268.
16.	张柏根, 薛冠华. 深静脉血栓形成的病因及高危因素. 中国实用外科杂志, 2003, 23(4): 197-200.

1. 邓宏平, 王志维, 夏军, 等. 急性复杂型 Stanford A 型主动脉夹层的外科治疗. 临床外科杂志, 2014, 22(10): 762-766.
2. Oderich GS, Panneton JM, Bower TC, et al. Aortic dissection with aortic side branch compromise: Impact of malperfusion on patient outcome. Perspect Vasc Surg Endovasc Ther, 2008, 20(2): 190-200.
3. 尚蔚, 刘楠, 闫晓蕾, 等. A 型主动脉夹层手术后早期并发症分析. 心肺血管病杂志, 2011, 30(3): 183-186.
4. 罗海燕, 胡克俭, 刘祖赟, 等. A 型主动脉夹层术后脑部并发症危险因素分析. 中华胸心血管外科杂志, 2009, 25(3): 148-150.
5. 闫成雷, 高长青, 肖苍松, 等. Stanford A 型主动脉夹层年轻患者的临床特点. 中国胸心血管外科临床杂志, 2012, 19(3): 251-253.
6. 中国成人血脂异常防治指南制订联合委员会. 中国成人血脂异常防治指南. 中华心血管病杂志, 2007, 35(5): 390-419.
7. 张凯, 潘旭东, 董松波, 等. 颈动脉粥样硬化与急性 Stanford A 型主动脉夹层术后中枢神经系统并发症的相关性研究. 心肺血管病杂志, 2018, 37(3): 201-205.
8. Svensson LG, Crawford ES, Hess KR, et al. Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg, 1993, 106(1): 19-28.
9. 李辉, 李娟, 王振东, 等. Stanford A 型主动脉夹层术后早期发生脑血管事件相关危险因素分析. 心肺血管病杂志, 2020, 39(1): 44-48.
10. Smith A, Patterson C, Yarnell J, et al. Which hemostatic markers add to the predictive value of conventional risk factors for coronary heart disease and ischemic stroke? The Caerphilly Study. Circulation, 2005, 112(20): 3080-3087.
11. 王兆钺. D 二聚体临床应用的进展. 血栓与止血学, 2014, 20(1): 46-48.
12. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
13. Vele E, Kurtcehajic A, Zerem E, et al. Plasma D-dimer as a predictor of the progression of abdominal aortic aneurysm. J Thromb Haemost, 2016, 14(11): 2298-2303.
14. 李明辉, 时露. 血栓和出血性疾病中血栓弹力图与常规凝血功能检测指标的相关性分析. 现代医药卫生, 2016, 32(17): 2703-2704.
15. 范焕青, 张金涛. 青年脑梗死发病的相关危险因素研究进展. 实用医药杂志, 2010, 27(3): 266-268.
16. 张柏根, 薛冠华. 深静脉血栓形成的病因及高危因素. 中国实用外科杂志, 2003, 23(4): 197-200.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The reduction of coagulation factor activity R before surgery increases the risk of postoperative neurological complications in patients with acute type A aortic dissection

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