Abstract
BackgroundPatent false lumen has been shown to have a negative impact on prognosis after surgery for acute type A aortic dissection (ATAAD). We aimed to assess the effect of postoperative anticoagulation on false lumen patency and clinical outcomes in relation to false lumen status.MethodsPostoperative computed tomographies of 156 patients undergoing ATAAD DeBakey type I surgery were retrospectively evaluated for false lumen patency. The patients were divided into groups determined by anticoagulation treatment at discharge. Uni- and multivariable logistic regression was used for analysing the effect of anticoagulation on the false lumen, and Kaplan–Meier estimates were used to assess the association of a patent false lumen with the incidence of reoperation and long-term survival.ResultsA patent false lumen was present in 81% of the patients. Postoperative anticoagulants were not associated with a patent false lumen (p = 0.48) in univariable analysis. In multivariable analysis, both hemiarch replacement (OR 0.15, CI95% 0.05–0.49, p = 0.001) and the use of betablockers had a protective effect (OR 0.29, CI95% 0.10–0.85, p = 0.023). The Kaplan–Meier estimates for survival and the composite endpoint of survival and freedom from distal reintervention indicated no difference in outcome between patients in regard to anticoagulation treatment (survival p = 0.43, composite p = 0.82) or false lumen status (survival p = 0.21, composite p = 0.09).ConclusionThis study could not show negative effects from the postoperative use of anticoagulants on false lumen status, nor that false lumen patency was associated with poorer prognosis. A hemiarch procedure was shown to be associated with reduced risk of false lumen patency.
Highlights
Acute type A aortic dissection (ATAAD) requires emergent surgical repair primarily to prevent ascending aortic rupture, cardiac tamponade, acute aortic valve insufficiency with consequent ventricular dysfunction, Larsson et al J Cardiothorac Surg (2021) 16:279 reintervention aimed at the distal aorta(1–4)
36% of patients (n = 56) received anticoagulation treatment, 18 patients were treated with Non vitamin-K antagonist oral anticoagulant (NOAC), and Warfarin anticoagulation or NOAC
This study shows that treatment with betablockers is beneficial after surgery for acute type A aortic dissection (ATAAD), reducing the risk of a patent false lumen, probably indicating the importance of strict postoperative blood pressure control
Summary
Acute type A aortic dissection (ATAAD) requires emergent surgical repair primarily to prevent ascending aortic rupture, cardiac tamponade, acute aortic valve insufficiency with consequent ventricular dysfunction, Larsson et al J Cardiothorac Surg (2021) 16:279 reintervention aimed at the distal aorta(1–4). Studies of type B dissection have suggested that patients with complete thrombosis of the false lumen have improved outcomes, whereas those with a patent false lumen have an increased risk of aortic enlargement and death [1,2,3]. Anticoagulation therapy after surgery for ATAAD is indicated if the patient has a mechanical valve implantation or atrial fibrillation. The rate of false lumen thrombus formation in relation to anticoagulation therapy has been studied previously, and these studies indicate similar or higher rates of false lumen patency in patients using anticoagulants [4,5,6]. Patent false lumen has been shown to have a negative impact on prognosis after surgery for acute type A aortic dissection (ATAAD). We aimed to assess the effect of postoperative anticoagulation on false lumen patency and clinical outcomes in relation to false lumen status
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