Background: 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.
Methods: 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.
Results: Compared with controls, patients treated with rFVIIa receivedmore 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 ¼ .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 ¼ .01) underwent
reexploration for bleedingmore often (31.0%vs 16.8%; P¼.014); 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 ¼ .487), postoperative stroke (OR, 1.75; 95% CI, 0.82-3.91;
P ¼ .163), or RRT (OR, 1.18; 95% CI, 0.48-2.92; P ¼ .839).
Conclusions: 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. (J
Thorac Cardiovasc Surg 2017;154:1852-9)