A Case of Heparin-Induced Thrombocytopenia (HIT) following Aortic Surgery for Acute Type A Aortic Dissection

Over the decades, it has been well established that malperfusion complicates a number of acute type A aortic dissection (ATAAD) patients. Of the many complications that arise from ATAAD is malperfusion, which is the result of true lumen compression secondary to the dissection, and it is one of the most dangerous complications. Left untreated, malperfusion can eventually compromise circulation to the vascular beds of almost all vital organs. Clinicians must consider the diagnosis of malperfusion promptly following a diagnosis of acute aortic dissection. The outcomes post-surgery for patients with ATAAD with concomitant malperfusion remains poor, despite mortality for aortic surgery improving over time. Optimal management for ATAAD with associated malperfusion has yet to be implemented, further research is warranted to improve the detection and management of this potentially fatal pathology. In this review, we explore the literature surrounding the complications of malperfusion in ATAAD and the various symptom presentations, investigations, and management strategies available.

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A Case of Heparin-Induced Thrombocytopenia (HIT) with Postoperative Cerebral Infarction Following Surgical Repair of Acute Type A Aortic Dissection

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.39.17 ◽

2010 ◽

Vol 39 (1) ◽

pp. 17-20 ◽

Cited By ~ 1

Author(s):

Atsutomo Morishima ◽

Kouzou Kaneda ◽

Yuichi Yoshida ◽

Daisuke Heima ◽

Shingo Hirao ◽

...

Keyword(s):

Aortic Dissection ◽

Cerebral Infarction ◽

Surgical Repair ◽

Type A ◽

Acute Type ◽

Heparin Induced Thrombocytopenia ◽

Type A Aortic Dissection

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A Case of Loeys-Dietz Syndrome That Caused Rapid Enlargement of the Distal Aortic Arch Following Aortic Surgery for Acute Type A Aortic Dissection

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.41.316 ◽

2012 ◽

Vol 41 (6) ◽

pp. 316-319

Author(s):

Takashi Yoshinaga ◽

Ryuji Kunitomo ◽

Shuji Moriyama ◽

Ken Okamoto ◽

Hisashi Sakaguchi ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Aortic Surgery ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Rapid Enlargement

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Research on clinical characteristics and prognostic analysis of heparin-induced thrombocytopenia after surgery for acute type a aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01482-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Chu-zhi Zhou ◽

Dong-jie Feng ◽

Yuan Fang ◽

Feng-yan Zha ◽

Er-hui Wang ◽

...

Keyword(s):

Aortic Dissection ◽

Clinical Characteristics ◽

Blood Platelets ◽

Type A ◽

Acute Type ◽

Heparin Induced Thrombocytopenia ◽

Type A Aortic Dissection ◽

Icu Stay ◽

Prognostic Analysis ◽

Length Of Icu Stay

Abstract Purpose The present study aimed to explore the clinical characteristics of heparin-induced thrombocytopenia (HIT) after surgery for acute type A aortic dissection and perform a relevant prognostic analysis. Methods After continuous observation and analysis of 204 patients who underwent acute type A aortic dissection, we found that blood platelets decreased significantly after surgery and that these patients can be suspected to suffer HIT based on relevant 4Ts scores. For these suspected HIT patients, a latex particle-enhanced immunoturbidimetric assay was conducted to detect heparin-induced antibodies. Perioperative clinical data of patients in HIT and non-HIT groups were recorded as were blood platelet counts, HIT antibody test results, 4Ts scores, thromboembolic complications, clinical prognosis and outcomes. Results In the present study, 38 suspected HIT patients, 16 HIT patients and 188 non-HIT patients were selected in the clinical setting. Among them, HIT patients were found to have prolonged cardiopulmonary bypass time (223 min on average vs. 164 min) and delayed aortic cross-clamp time (128 min on average vs. 107 min), and these differences between HIT patients and non-HIT patients were significant (P < 0.05). Additionally, the HIT group required longer operation time and higher dose of heparin, but showing no statistical differences (P > 0.05). The transfusions of blood platelets in the HIT group and non-HIT group were 18.7 ± 5.0u and 15.6 ± 7.34 u, respectively. In the HIT group, the mechanic ventilation time and the length of ICU stay were longer comparing the non-HIT group(P < 0.05), though no significant differences in total length of stay or In-hospital mortality were observed (P > 0.05). The incidence of continuous renal replacement therapy in HIT group was higher than the non-HIT group (P < 0.05). Additionally,there were no significant differences in 24-h postoperative drainage or reoperation for bleeding in both group(P > 0.05). However, the HIT antibody titer in the HIT group was significantly higher than that in the Suspected HIT group (2.7 ± 0.8 U/mL vs. 0.3 ± 0.2 U/mL) (P < 0.05). Among patients diagnosed with HIT, the incidence of thromboembolism reached 31.5%.For example, two HIT patients newly developed thromboembolism in both lower extremities,and three patients experienced cerebral infarction. Conclusions After surgery for acute type A aortic dissection, HIT patients developed postoperative complications, the duration of ventilatory support and length of ICU stay were extended, and the incidence of thromboembolism increased. HIT antibody detection and risk classification should be implemented for high-risk patients showing early clinical characteristics.

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Research on Clinical Characteristics and Prognostic Analysis of Heparin-Induced Thrombocytopenia After Surgery for Acute Type a Aortic Dissection

10.21203/rs.3.rs-114646/v1 ◽

2020 ◽

Author(s):

Chu-zhi Zhou ◽

Yan-zhen Li ◽

Dong-jie Feng ◽

Yuan Fang ◽

Feng-yan Zha ◽

...

Keyword(s):

Aortic Dissection ◽

Clinical Characteristics ◽

Blood Platelets ◽

Type A ◽

Acute Type ◽

Heparin Induced Thrombocytopenia ◽

Type A Aortic Dissection ◽

Icu Stay ◽

Prognostic Analysis ◽

Length Of Icu Stay

Abstract PurposeThe present study aimed to explore the clinical characteristics of heparin-induced thrombocytopenia (HIT) after surgery for acute type A aortic dissection and perform a relevant prognostic analysis. MethodsAfter continuous observation and analysis of 204 patients who underwent acute type A aortic dissection, we found that blood platelets decreased significantly after surgery and that these patients can be suspected to suffer HIT based on relevant 4Ts scores. For these suspected HIT patients, a latex particle-enhanced immunoturbidimetric assay was conducted to detect heparin-induced antibodies. Perioperative clinical data of patients in HIT and non-HIT groups were recorded as were blood platelet counts, HIT antibody test results, 4Ts scores, thromboembolic complications, clinical prognosis and outcomes. ResultsIn the present study, 38 suspected HIT patients, 16 HIT patients and 188 non-HIT patients were selected in the clinical setting. Among them, HIT patients were found to have prolonged cardiopulmonary bypass time(223min on average vs. 164min) and delayed aortic cross-clamp time(128min on average vs. 107min), and these differences between HIT patients and non-HIT patients were significant (P<0.05). Additionally, the HIT group required longer operation time and higher dose of heparin, but showing no statistical differences(P>0.05). The transfusions of blood platelets in the HIT group and non-HIT group were 18.7±5.0u and 15.6±7.34 u, respectively.In the HIT group, the mechanic ventilation time and the length of ICU stay were longer comparing the non-HIT group(P<0.05), though no significant differences in total length of stay or In-hospital mortality were observed (P>0.05).The incidence of continuous renal replacement therapy in HIT group was higher than the non-HIT group(P<0.05). Additionally,there were no significant differences in 24-h postoperative drainage or reoperation for bleeding in both group(P>0.05). However, the HIT antibody titer in the HIT group was significantly higher than that in the Suspected HIT group(2.7±1.8U/mL vs. 0.3±0.2U/mL)(P<0.05).Among patients diagnosed with HIT, the incidence of thromboembolism reached 31.5%.For example, two HIT patients newly developed thromboembolism in both lower extremities,and three patients experienced cerebral infarction. ConclusionsAfter surgery for acute type A aortic dissection, HIT patients developed postoperative complications, the duration of ventilatory support and length of ICU stay were extended, and the incidence of thromboembolism increased. HIT antibody detection and risk classification should be implemented for high-risk patients showing early clinical characteristics.

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Operative Strategies and Outcomes in Type a Aortic Dissection after the Enactment of a Multidisciplinary Aortic Surgery Team

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000212 ◽

2015 ◽

Vol 10 (6) ◽

pp. 410-415 ◽

Cited By ~ 7

Author(s):

Jared P. Beller ◽

Joshua A. Scheinerman ◽

Leora B. Balsam ◽

Patricia Ursomanno ◽

Abe DeAnda

Keyword(s):

Aortic Dissection ◽

Patient Outcomes ◽

Acute Aortic Dissection ◽

Operative Mortality ◽

Aortic Surgery ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

International Registry ◽

Operative Strategies

Objective The purpose of this study was to compare operative strategies and patient outcomes in acute type A aortic dissection (ATAAD) repairs before and after the implementation of a multi-disciplinary aortic surgery team. Methods Between May 2005 and July 2014, 101 patients underwent ATAAD repair at our institution. A dedicated multidisciplinary aortic surgery team (experienced aortic surgeon, perfusionists, cardiac anesthesiologists, nurses, and radiologists) was formed in 2010. We retrospectively compared ATAAD repair outcomes in patients before (2005–2009, N = 39) and after (2010–2014, N = 62) implementation of our program. Expected operative mortality was calculated using the International Registry of Acute Aortic Dissection preoperative predictive model. Results This study demonstrated a significant reduction in operative mortality after implementation of the aortic surgery program (30.8% vs. 9.7%; P = 0.014). There was also an increase in the complexity of surgical technique and perfusion strategies with fewer postoperative complications related to respiratory (P < 0.0001) and renal failure (P = 0.034). Baseline demographics were similar, and there was no statistically significant difference in International Registry of Acute Aortic Dissection predictive variables between the 2 groups. However, there was a 3.5-fold reduction in the observed-to-expected (O/E) operative mortality ratio. There was a 50% increase in volume with a significant number of patients being admitted directly to our aortic center for ATAAD repair, thus avoiding delay in operation related to transfers from a secondary hospital. Conclusions Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.

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Rapid Diagnosis and Treatment of Patients with Acute Type A Aortic Dissection and Malperfusion Syndrome May Normalize Survival to that of Patients with Uncomplicated Type A Aortic Dissection

Aorta ◽

10.1055/s-0039-1691790 ◽

2019 ◽

Vol 07 (02) ◽

pp. 042-048 ◽

Cited By ~ 1

Author(s):

Syed Usman Bin Mahmood ◽

Makoto Mori ◽

Jiajun Luo ◽

Yawei Zhang ◽

Basmah Safdar ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Surgery ◽

Type A ◽

Multivariate Regression Analysis ◽

Acute Type ◽

Type A Aortic Dissection ◽

Acute Type A Dissection ◽

Operative Outcomes ◽

Nonsignificant Difference ◽

Malperfusion Syndrome

Objectives Malperfusion syndrome in the setting of acute Type A dissection (ATAD) is typically associated with poor prognosis. We evaluated the contemporary outcomes of patients with ATAD presenting with and without malperfusion syndrome who underwent aortic surgery. Methods We performed a single-center, retrospective review of 103 consecutive patients that underwent surgery for ATAD. The cohort was dichotomized by patients with and without malperfusion syndromes. Multivariate and bivariate analyses were performed to evaluate association between the presence of malperfusion syndrome and operative outcomes. Results A total of 29 (28.1%) patients presented with malperfusion syndrome. The 30-day mortality for patients presenting with and without malperfusion was 13.7 and 9.4%, respectively (p = 0.49). Patients with malperfusion syndrome had a shorter mean admission-to-incision interval of 4.3 ± 2.5 hours compared with 6.3 ± 4.6 hours for those without malperfusion (p = 0.02). Difference in 30-day mortality for patients with and without malperfusion syndrome was found to be nonsignificant on multivariate regression analysis (odds ratio: 1.53; 95% confidence interval: 0.40–5.82, p = 0.49). Conclusions This series demonstrated that there was nonsignificant difference in early- or midterm outcomes for patients with and without malperfusion syndrome. Patients with malperfusion were taken to the operating room more rapidly than those without, which offers a potential explanation for the comparable outcome of the malperfusion cohort.

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