Gastrointestinal bleeding risk factors in type A aortic dissection post-aortic arch replacement

Junhai Hao; Jiaxin Li; Hanxiao Zhang; Jia Chen; Miaoxian Fang; Meifen Wu; Bowen Gu; Yingkai Xiao; Liming Lei

doi:10.21037/jtd-23-1752

Gastrointestinal bleeding risk factors in type A aortic dissection post-aortic arch replacement

J Thorac Dis. 2024 Apr 30;16(4):2314-2325. doi: 10.21037/jtd-23-1752. Epub 2024 Apr 10.

Authors

Junhai Hao^#^{1

2

3}, Jiaxin Li^#^{1

2}, Hanxiao Zhang^#^{1

2}, Jia Chen^{1

2}, Miaoxian Fang^{1

2}, Meifen Wu^{1

2}, Bowen Gu^{1

2}, Yingkai Xiao^{1

2}, Liming Lei^{1

2}

Affiliations

¹ Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
² Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China.
³ School of Medicine, South China University of Technology, Guangzhou, China.

^# Contributed equally.

Abstract

Background: Gastrointestinal bleeding (GIB) is a notable complication in patients diagnosed with aortic dissection (AD). We evaluated the outcomes and identified the risk factors associated with GIB in patients with AD.

Methods: A retrospective case-control study was conducted on patients diagnosed with type A aortic dissection (TAAD) who underwent total aortic arch replacement (TAAR) at our institution from July 2021 to July 2023. Comprehensive clinical data, laboratory findings, and imaging results were meticulously gathered and analyzed to identify potential risk factors linked to GIB in this patient cohort.

Results: Of the 198 AD patients who underwent TAAR, 38 (19.2%) developed postoperative GIB (GIB group), with a median interval of 7 days between surgery and bleeding onset. The GIB group exhibited significantly higher mortality (26.3% vs. 3.1%, P<0.001), prolonged intensive care unit (ICU) stay {15 [interquartile range (IQR), 8-25] vs. 7 (IQR, 5-12) days, P<0.001}, and extended duration of ventilation [168 (IQR, 120-372) vs. 71 (IQR, 34-148) hours, P<0.001] compared to the control group (n=160, 80.8%). Logistic regression analysis identified age >54 years [odds ratio (OR): 3.529], intraoperative red blood cell (RBC) transfusion >600 mL (OR: 3.865), and concomitant celiac trunk and superior mesenteric artery (SMA) hypoperfusion (OR: 15.974) as independent risk factors for GIB in AD patients.

Conclusions: GIB subsequent to TAAR in AD patients is linked to adverse prognosis. Factors such as advanced age, extensive intraoperative transfusion, and gastrointestinal (GI) perfusion abnormalities may heighten the risk of GIB in this patient population.

Keywords: Type A aortic dissection (TAAD); gastrointestinal bleeding (GIB); perioperative period; retrospective analysis.