Recombinant factor VIIa use in acute type A aortic dissection repair: A multicenter propensity-score-matched report from the Nordic Consortium for Acute Type A Aortic Dissection.

• Published in: The Journal of Thoracic and Cardiovascular Surgery
• Main Authors: Zindovic, Igor, Sjögren, Johan, Ahlsson, Anders, Bjursten, Henrik, Fuglsang, Simon, Geirsson, Arnar, Ingemansson, Richard, Hansson, Emma C, Mennander, Ari, Olsson, Christian, Pan, Emily, Ullén, Susann, Gudbjartsson, Tomas, Nozohoor, Shahab
• Other Authors: 1 Lund Univ, Skane Univ Hosp, Dept Cardiothorac Surg, Clin Sci, Lund, Sweden 2 Clin Studies Sweden Forum South, Lund, Sweden Show more 3 Orebro Univ, Orebro Univ Hosp, Dept Cardiothorac & Vasc Surg, Orebro, Sweden Show more 4 Orebro Univ, Sch Hlth & Med, Orebro, Sweden Show more 5 Univ Gothenburg, Sahlgrenska Acad, Inst Med, Sahlgrenska Univ Hosp,Dept Cardiothorac Surg, Gothenburg, Sweden Show more 6 Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden Show more 7 Karolinska Univ Hosp, Dept Thorac & Cardiovasc Surg, Stockholm, Sweden 8 Aarhus Univ Hosp, Dept Thorac & Cardiovasc Surg, Skejby, Sweden Show more 9 Univ Iceland, Landspitali Univ Hosp, Reykjavik, Iceland Show more 10 Univ Iceland, Fac Med, Reykjavik, Iceland Show more 11 Tampere Univ Hosp, Heart Ctr, Tampere, Finland Show more 12 Turku Univ Hosp, Heart Ctr, Turku, Finland Show more 13 Univ Turku, Turku, Finland
• Format: Article in Journal/Newspaper
• Language: English
• Published: Mosby-Elsevier 2018
• Subjects: Æðaskurðlækningar; Æðasjúkdómar; Ósæðargúll; TAS12; Aorta; Aneurysm; Dissection; Meier; Iceland
• Online Access: http://hdl.handle.net/2336/620498; https://doi.org/10.1016/j.jtcvs.2017.08.020

To access publisher's full text version of this article click on the hyperlink below Surgery for acute type A aortic dissection (ATAAD) is often complicated by excessive bleeding. Recombinant factor VIIa (rFVIIa) effectively treats refractory bleeding associated with ATAAD surgery; however, adverse effects of rFVIIa in these patients have not been fully assessed. Here we evaluated rFVIIa treatment in ATAAD surgery using the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database. This was a multicenter, propensity score-matched, retrospective study. Information about rFVIIa use was available for 761 patients, of whom 171 were treated with rFVIIa. We successfully matched 120 patients treated with rFVIIa with 120 controls. Primary endpoints were in-hospital mortality, postoperative stroke, and renal replacement therapy (RRT). Survival data were presented using Kaplan-Meier estimates. Compared with controls, patients treated with rFVIIa received more transfusions of packed red blood cells (median, 9.0 U [4.0-17.0 U] vs 5.0 U [2.0-11.0 U]; P = .008), platelets (4.0 U [2.0-8.0 U] vs 2.0 U [1.0-4.4 U]; P <.001), and fresh frozen plasma (8.0 U [4.0-18.0 U] vs 5.5 U [2.0-10.3 U]; P = .01) underwent reexploration for bleeding more often (31.0% vs 16.8%; P = .014); and had greater 24-hour chest tube output (1500 L [835-2500 mL] vs 990 mL [520-1720 mL]). Treatment with rFVIIa was not associated with significantly increased rates of in-hospital mortality (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.34-1.55; P = .487), postoperative stroke (OR, 1.75; 95% CI, 0.82-3.91; P = .163), or RRT (OR, 1.18; 95% CI, 0.48-2.92; P = .839). In this propensity-matched cohort study of patients undergoing ATAAD surgery, treatment with rFVIIa for major bleeding was not associated with a significantly increased risk of stroke, RRT, or mortality. University of Iceland Landspitali Mats Kleberg Foundation