Thromboelastography and interleukin-6 predict postoperative negative remodeling of descending aorta in patients with type A aortic dissection.

BACKGROUND

Negative remodeling (NR) is common in postoperative residual aortic dissection (AD) in patients with type A aortic dissection (AAD); however, reliable predictors for its assessment remain lacking. This study aimed to investigate the clinical value of thromboelastography (TEG) and interleukin-6 (IL-6) in predicting postoperative NR in patients with AAD.

METHODS

We analyzed patients who underwent total aortic arch replacement surgery for AAD between January 2020 and December 2021, and were monitored for 2 years postoperatively. All relevant data were collected and analyzed.

RESULTS

A total of 208 patients with AAD were included. The incidence of NR (group NR) in residual AD was 24.0% (n=50) with higher follow-up mortality (8.0% vs. 1.3%, P=0.01) and reoperation rate (10% vs. 1.9%, P=0.001). The NR group had significantly higher IL-6 levels (P<0.001) than the non-NR group. The TEG parameters showed that the reaction time (R-time) and kinetic time (K-time) of the NR group were longer (P<0.001), clot angle (P<0.001) and maximum clot firmness (P=0.04) were lower in the NR group than in the non-NR group. Spearman correlation analysis demonstrated significant positive correlations between IL-6, R-time, and K-time and the occurrence of NR (r=0.348, 0.371, and 0.371, respectively, P<0.001), whereas clot angle and maximum clot firmness showed negative correlations (r=-0.409 and -0.146, respectively, P<0.05). Multivariate regression analysis revealed that elevated IL-6 levels [odds ratio (OR) =3.910; P<0.001], R-time (OR =2.401; P=0.03), and K-time (OR =2.417; P=0.03) were risk factors for NR in residual AD. The receiver operating characteristic curve analysis showed that the cutoff points for R- and K-times combined with IL-6 had an area under the curve of 0.878, with the sensitivity and specificity of 96.0% and 62.0%, respectively (P<0.001).

CONCLUSIONS

TEG and IL-6 levels were effective predictors of the risk of postoperative NR of residual AD in patients with AAD.