title: Predictors and impact of massive bleeding in acute type A aortic dissection.
abstract: Bleeding complications associated with acute type A aortic dissection (aTAAD) are a well-known clinical problem. Here, we evaluated predictors of massive bleeding related to aTAAD and associated surgery and assessed the impact of massive bleeding on complications and survival.
  
  
  
  This retrospective study of 256 patients used Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART) criteria to define massive bleeding, which was met by 66 individuals (Group I) who were compared to the remaining patients (Group II). Multivariable logistic regression was used to identify independent predictors of massive bleeding and in-hospital mortality, Kaplan-Meier estimates for analysis of late survival, and Cox regression analysis to evaluate independent predictors of late mortality.
  
  
  
  Independent predictors of massive bleeding included symptom duration (odds ratio [OR], 0.974 per hour increment; 95% confidence interval [CI], 0.950-0.999; P  =   0.041) and DeBakey type 1 dissection (OR, 2.652; 95% CI, 1.004-7.008; P  =   0.049). In-hospital mortality was higher in Group I (30.3% vs 8.0%, P  <0.001). Kaplan-Meier estimates of survival indicated poorer survival for Group I at 1, 3 and 5 years (68.8 ± 5.9% vs 92.8 ± 1.9%; 65.2 ± 6.2% vs 85.3 ± 2.7%; 53.9 ± 6.9% vs 82.1 ± 3.3 %, respectively; log rank P  <   0.001). Re-exploration for bleeding was an independent predictor of in-hospital (OR, 3.109; 95% CI, 1.044-9.256; P  =   0.042) and late mortalities (hazard ratio, 3.039; 95% CI, 1.605-5.757; P  =   0.001).
  
  
  
  Massive bleeding in patients with aTAAD is prompted by shorter symptom duration and longer extent of dissection and has deleterious effects on outcomes of postoperative complications as well as in-hospital and late mortalities.
authors.affiliation: Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE, Lund, Sweden.
authors.forename: Igor
authors.initials: I
authors.lastname: Zindovic
authors.affiliation: Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE, Lund, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Sjögren
authors.affiliation: Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE, Lund, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bjursten
authors.affiliation: Department of Cardiology, University Hospital of Uppsala, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Björklund
authors.affiliation: Department of Neurosurgery, Lund University Hospital, Lund, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Herou
authors.affiliation: Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: Richard
authors.initials: R
authors.lastname: Ingemansson
authors.affiliation: Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE, Lund, Sweden.
authors.forename: Shahab
authors.initials: S
authors.lastname: Nozohoor
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aneurysm; Aorta; Dissecting; Haemorrhage; Reoperation