Mediastinal Packing for Massive Bleeding Following Acute Ascending Aortic Dissection Surgery: Outcomes and Risk Factors Analysis

Ahmed Shafeek Ali, cardiothoracic surgeryFollow
Mostafa Abd Al Salam Mohamed Ghazi, cardiothoracic surgery
Mahmoud Maher Abdou Ibrahim, cardiology
Haitham Alshahat Ramadan, cardiology

Article Type

Original Study

Subject Area

Cardiothoracic Surgery

Abstract

Background: Surgery for Acute Ascending Aortic Dissection (AAAD) is often complicated by severe perioperative coagulopathy and critical bleeding. Mediastinal packing is a widely recognised technique used to manage and control this complication. This retrospective study aims to analyze early outcomes and potential risk factors for patients subjected to mediastinal packing after AAAD surgery.

Methods: 352 consecutive patients who had undergone acute ascending aortic dissection (AAAD) surgery were studied at the National Heart Institution between February 2014 and Mars 2023. These patients were divided into two groups: the mediastinal packing with delayed closure group (n = 53; 15.05%) and the primary closure group (n =299; 84.94%). The study aimed to compare the clinical characteristics, surgical details, postoperative complications, and short-term outcomes between the two groups. A multivariate logistic regression analysis was conducted to recognize the independent risk factors for patients who had undergone mediastinal packing with delayed closure.

Results: The mediastinal packing group (MP) exhibited a greater incidence of preoperative hemopericardium and malperfusion. This group was also linked to extended periods of cardiopulmonary bypass (CPB) and aortic clamping times. Additionally, the MP group had higher rates of prolonged intraoperative CPB support. Moreover, other parameters as blood product transfusion and rate of re-exploration were significantly higher in the mediastinal packing group. However, the in-hospital mortality rates (20.75% vs. 12.70%; P = 0.267), Deep sternal wound infection rates (5.66% vs. 2.67%; P = 0.091), and total Hospital stay (days) (28.8 ± 32.4vs. 24.8 ± 28.5; P = 0.161), were comparable between both groups. Multivariate analysis revealed that hemopericardium, preoperative malperfusion, and prolonged intraoperative CPB support were risk factors for undergoing mediastinal packing procedures.

Conclusion: Mediastinal packing is an effective technique to stabilize patients who are experiencing uncontrollable bleeding following surgery for AAAD. This technique has been shown to result in satisfactory postoperative outcomes. It is recommended that patients with uncontrollable bleeding should have prompt consideration for implementing mediastinal packing with delayed closure.

IRB Number

IHC00088

Keywords

Mediastinal packing, Acute Ascending Aortic Dissection, Bleeding

Recommended Citation

Ali, Ahmed Shafeek; Ghazi, Mostafa Abd Al Salam Mohamed; Ibrahim, Mahmoud Maher Abdou; and Ramadan, Haitham Alshahat (2024) "Mediastinal Packing for Massive Bleeding Following Acute Ascending Aortic Dissection Surgery: Outcomes and Risk Factors Analysis," Journal of Medicine in Scientific Research: Vol. 7: Iss. 3, Article 11.
DOI: https://doi.org/10.59299/2537-0928.1398