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A prospective, controlled study on the utility of rotational thromboelastometry in surgery for acute type A aortic dissection
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  • Mårten Larsson,
  • Igor Zindovic,
  • Johan Sjögren,
  • Peter Svensson J,
  • Karin Strandberg,
  • Shahab Nozohoor
Mårten Larsson
Lund University Skåne University Hospital Department of Clinical Sciences Lund Department of Cardiothoracic Surgery Lund Sweden

Corresponding Author:[email protected]

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Igor Zindovic
Lund University Skåne University Hospital Department of Clinical Sciences Lund Department of Cardiothoracic Surgery Lund Sweden
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Johan Sjögren
Lund University Skåne University Hospital Department of Clinical Sciences Lund Department of Cardiothoracic Surgery Lund Sweden
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Peter Svensson J
Department of Coagulation Disorders Skåne University Hospital Lund University Malmö Sweden
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Karin Strandberg
Department of Clinical Chemistry Malmö Sweden
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Shahab Nozohoor
Lund University Skåne University Hospital Department of Clinical Sciences Lund Department of Cardiothoracic Surgery Lund Sweden
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Abstract

Objective: To evaluate the hemostatic system with ROTEM in patients undergoing surgery for acute type aortic dissection (ATAAD) using elective aortic procedures as controls. Design: This was a prospective, controlled, observational study. Setting: The study was performed at a tertiary referral center and university hospital. Participants: Twenty-three patients with ATAAD were compared to 20 control patients undergoing elective surgery of the ascending aorta or the aortic root. Results: ROTEM (INTEM, EXTEM, HEPTEM and FIBTEM) was tested at 6 points in time before, during and after surgery for ATAAD or elective aortic surgery. The ATAAD group had an activated coagulation coming into the surgical theatre. The two groups showed activation of both major coagulation pathways during surgery, but the ATAAD group consistently had larger deficiencies. Reversal of the coagulopathy was successful, although none of the groups reached elective baseline until postoperative day 1. ROTEM did not detect low levels of clotting factors at heparin reversal nor low levels of platelets. Conclusions: This study demonstrated that ATAAD is associated with a coagulopathic state. Surgery causes additional damage to the hemostatic system in ATAAD patients as well as in patients undergoing elective surgery of the ascending aorta or the aortic root. ROTEM does not adequately catch the full coagulopathy in ATAAD. A transfusion protocol in ATAAD should be specifically created to target this complex coagulopathic state and ROTEM does not negate the need for routine laboratory tests.
06 Mar 2022Submitted to Journal of Cardiac Surgery
06 Mar 2022Submission Checks Completed
06 Mar 2022Assigned to Editor
07 Mar 2022Reviewer(s) Assigned
11 Apr 2022Review(s) Completed, Editorial Evaluation Pending