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

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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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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, 劉楠, 閆曉蕾, 等. A 型主動脈夾層手術后早期并發癥分析. 心肺血管病雜志, 2011, 30(3): 183-186.
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5.	閆成雷, 高長青, 肖蒼松, 等. Stanford A 型主動脈夾層年輕患者的臨床特點. 中國胸心血管外科臨床雜志, 2012, 19(3): 251-253.
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7.	張凱, 潘旭東, 董松波, 等. 頸動脈粥樣硬化與急性 Stanford A 型主動脈夾層術后中樞神經系統并發癥的相關性研究. 心肺血管病雜志, 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.	李輝, 李娟, 王振東, 等. Stanford A 型主動脈夾層術后早期發生腦血管事件相關危險因素分析. 心肺血管病雜志, 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.	王兆鉞. D 二聚體臨床應用的進展. 血栓與止血學, 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.	李明輝, 時露. 血栓和出血性疾病中血栓彈力圖與常規凝血功能檢測指標的相關性分析. 現代醫藥衛生, 2016, 32(17): 2703-2704.
15.	范煥青, 張金濤. 青年腦梗死發病的相關危險因素研究進展. 實用醫藥雜志, 2010, 27(3): 266-268.
16.	張柏根, 薛冠華. 深靜脈血栓形成的病因及高危因素. 中國實用外科雜志, 2003, 23(4): 197-200.

1. 鄧宏平, 王志維, 夏軍, 等. 急性復雜型 Stanford A 型主動脈夾層的外科治療. 臨床外科雜志, 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, 劉楠, 閆曉蕾, 等. A 型主動脈夾層手術后早期并發癥分析. 心肺血管病雜志, 2011, 30(3): 183-186.
4. 羅海燕, 胡克儉, 劉祖赟, 等. A 型主動脈夾層術后腦部并發癥危險因素分析. 中華胸心血管外科雜志, 2009, 25(3): 148-150.
5. 閆成雷, 高長青, 肖蒼松, 等. Stanford A 型主動脈夾層年輕患者的臨床特點. 中國胸心血管外科臨床雜志, 2012, 19(3): 251-253.
6. 中國成人血脂異常防治指南制訂聯合委員會. 中國成人血脂異常防治指南. 中華心血管病雜志, 2007, 35(5): 390-419.
7. 張凱, 潘旭東, 董松波, 等. 頸動脈粥樣硬化與急性 Stanford A 型主動脈夾層術后中樞神經系統并發癥的相關性研究. 心肺血管病雜志, 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. 李輝, 李娟, 王振東, 等. Stanford A 型主動脈夾層術后早期發生腦血管事件相關危險因素分析. 心肺血管病雜志, 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. 王兆鉞. D 二聚體臨床應用的進展. 血栓與止血學, 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. 李明輝, 時露. 血栓和出血性疾病中血栓彈力圖與常規凝血功能檢測指標的相關性分析. 現代醫藥衛生, 2016, 32(17): 2703-2704.
15. 范煥青, 張金濤. 青年腦梗死發病的相關危險因素研究進展. 實用醫藥雜志, 2010, 27(3): 266-268.
16. 張柏根, 薛冠華. 深靜脈血栓形成的病因及高危因素. 中國實用外科雜志, 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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