Journal of cardiothoracic and vascular anesthesia · 2025
Preoperative Hematocrit Is Not Associated With Stroke After Surgery for Acute Type A Aortic Dissection.
СтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Brown James A, Feng Zihan, Tarun Shwetabh, Stoll Veenah, Serna-Gallegos Derek, Hasan Irsa, Ogami Takuya, Thoma Floyd, Zhu Jianhui, Subramaniam Kathirvel, Phillippi Julie, Sultan Ibrahim
Аннотация
OBJECTIVE: To determine the impact of hematocrit on adverse neurologic events after acute type A aortic dissection (ATAAD) repair under deep hypothermic circulatory arrest.
DESIGN: Retrospective study of consecutive aortic surgeries from 2010 to 2021.
SETTING: Single institution.
PARTICIPANTS: Patients undergoing open ATAAD repairs, excluding those with preoperative cerebral malperfusion syndrome (defined as neurologic deficit with radiographic evidence of cerebral branch vessel malperfusion).
INTERVENTIONS: Patients were split into three groups: normal, low, and high hematocrit.
MEASUREMENTS & MAIN RESULTS: A total of 527 patients were included, of which 355 (67.3%) had normal hematocrit, 143 (27.1%) had low hematocrit, and 29 (5.5%) had high hematocrit. Overall, 20 (3.8%) patients had a postoperative stroke, which was comparable across groups (p = 0.59). Patients with normal hematocrit had lower in-hospital mortality (p = 0.02) and lower transfusion rates (p < 0.001), while re-exploration for bleeding was similar across groups (p = 0.68). After multivariable adjustment, there was no association between hematocrit and postoperative stroke (odds ratio [OR]: 1.00, 95% confidence interval [CI]: 0.99, 1.00, p = 0.79). Compared with normal hematocrit, there was no association between low hematocrit (OR: 1.59, 95% CI: 0.77, 3.28, p = 0.21) or high hematocrit (OR: 2.48, 95% CI: 0.74, 8.29, p = 0.14) and in-hospital mortality.
CONCLUSIONS: Preoperative hematocrit was not associated with stroke or mortality after ATAAD repair. The rheologic effect of hematocrit on cerebral perfusion under deep hypothermia may be minimal.
DESIGN: Retrospective study of consecutive aortic surgeries from 2010 to 2021.
SETTING: Single institution.
PARTICIPANTS: Patients undergoing open ATAAD repairs, excluding those with preoperative cerebral malperfusion syndrome (defined as neurologic deficit with radiographic evidence of cerebral branch vessel malperfusion).
INTERVENTIONS: Patients were split into three groups: normal, low, and high hematocrit.
MEASUREMENTS & MAIN RESULTS: A total of 527 patients were included, of which 355 (67.3%) had normal hematocrit, 143 (27.1%) had low hematocrit, and 29 (5.5%) had high hematocrit. Overall, 20 (3.8%) patients had a postoperative stroke, which was comparable across groups (p = 0.59). Patients with normal hematocrit had lower in-hospital mortality (p = 0.02) and lower transfusion rates (p < 0.001), while re-exploration for bleeding was similar across groups (p = 0.68). After multivariable adjustment, there was no association between hematocrit and postoperative stroke (odds ratio [OR]: 1.00, 95% confidence interval [CI]: 0.99, 1.00, p = 0.79). Compared with normal hematocrit, there was no association between low hematocrit (OR: 1.59, 95% CI: 0.77, 3.28, p = 0.21) or high hematocrit (OR: 2.48, 95% CI: 0.74, 8.29, p = 0.14) and in-hospital mortality.
CONCLUSIONS: Preoperative hematocrit was not associated with stroke or mortality after ATAAD repair. The rheologic effect of hematocrit on cerebral perfusion under deep hypothermia may be minimal.