초록접수 현황
| 15F-079 | 구연 발표 |
Bleeding Problem in Surgical Repair of Acute Type A Aortic Dissection;
a Different Point of View
Jung Hee Kim, Sue Hyun Kim, Suryeun Chung, Dong Jung Kim, Jun Sung Kim, Cheong Lim, Kay-Hyun Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
Background : Bleeding is a problem frequently encountered in surgical management of acute type A dissection. We assumed that its practical impact may not be fully reflected by conventional parameters such as the incidence of reoperation, transfusion amount, and chest tube drainage. We aimed to identify the problem of difficult intraoperative hemostasis and its association with postoperative bleeding complications and other clinical features.
Methods : The hospital records were retrospectively reviewed for 190 patients (mean age 57.1±14.8 years) who underwent emergent surgical repair for acute type A dissection from January 2006 through December 2014. Intraoperative hemostasis difficulty (IHD) was defined as either need of sternal closure with local compressive measures (gauze packing or patch coverage of the perigraft space) or excessive (>140min) time consumed between CPB termination and skin closure. Postoperative bleeding (POB) was defined as one of the following; re-exploration due to bleeding, postoperative RBC transfusion > 6units, or 24-hour chest tube drainage >2400ml.
Results : IHD occurred in 52 patients (27.4%) and POB occurred in 53 patients (27.9%) including 28 patients (14.7%) who needed re-exploration for bleeding. As the two problems coincided in 29 patients, 44.2% of IHD did not lead to POB and 45.3% of POB occurred without IHD. The factors significantly associated with IHD in multivariate analysis were symptom onset within 24hours before surgery (47/132=35.6% vs 5/58=8.6%, p=0.003), DeBakey type I vs type II (48/155=31.0% vs 4/35=11.4%, p=0.014), total arch replacement (22/58=37.9% vs 30/132=22.7%, p=0.045), and recent antiplatelet or other antihemostatic therapy (23/50=46.0% vs 29/140=20.7%, p<0.001). However, none of such factors were significantly associated with POB for which the risk factors were no use of aprotinin and prolonged cardiopulmonary bypass. The primary aortic surgeon resulted in significantly lower incidence of the composite outcome of IHD and POB compared with second-line surgeons (61/167=36.5% vs 15/23=65.2%).
Conclusion : The parameters regarding the postoperative bleeding complications after acute type A dissection repair do not fully reflect the surgeon’s difficulty and effort for overcoming intraoperative bleeding problem. We believe that meticulous performance of surgery and experience may overcome a substantial proportion of factors that increase the risk of postoperative bleeding.
Methods : The hospital records were retrospectively reviewed for 190 patients (mean age 57.1±14.8 years) who underwent emergent surgical repair for acute type A dissection from January 2006 through December 2014. Intraoperative hemostasis difficulty (IHD) was defined as either need of sternal closure with local compressive measures (gauze packing or patch coverage of the perigraft space) or excessive (>140min) time consumed between CPB termination and skin closure. Postoperative bleeding (POB) was defined as one of the following; re-exploration due to bleeding, postoperative RBC transfusion > 6units, or 24-hour chest tube drainage >2400ml.
Results : IHD occurred in 52 patients (27.4%) and POB occurred in 53 patients (27.9%) including 28 patients (14.7%) who needed re-exploration for bleeding. As the two problems coincided in 29 patients, 44.2% of IHD did not lead to POB and 45.3% of POB occurred without IHD. The factors significantly associated with IHD in multivariate analysis were symptom onset within 24hours before surgery (47/132=35.6% vs 5/58=8.6%, p=0.003), DeBakey type I vs type II (48/155=31.0% vs 4/35=11.4%, p=0.014), total arch replacement (22/58=37.9% vs 30/132=22.7%, p=0.045), and recent antiplatelet or other antihemostatic therapy (23/50=46.0% vs 29/140=20.7%, p<0.001). However, none of such factors were significantly associated with POB for which the risk factors were no use of aprotinin and prolonged cardiopulmonary bypass. The primary aortic surgeon resulted in significantly lower incidence of the composite outcome of IHD and POB compared with second-line surgeons (61/167=36.5% vs 15/23=65.2%).
Conclusion : The parameters regarding the postoperative bleeding complications after acute type A dissection repair do not fully reflect the surgeon’s difficulty and effort for overcoming intraoperative bleeding problem. We believe that meticulous performance of surgery and experience may overcome a substantial proportion of factors that increase the risk of postoperative bleeding.
책임저자: Kay-Hyun Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
연락처 : Jung Hee Kim, Tel: 010-8858-7330 , E-mail : jackie0619@hanmail.net
