Association between preoperative D-dimer with morphologic features and surgical outcomes of acute type A aortic dissection.

Objectives: The Association between preoperative D-dimer with morphologic features and surgical outcomes of Acute Type A Aortic Dissection (ATAAD) is still unclear.

Methods: 430 ATAAD patients who underwent total arch replacement (TAR) and frozen elephant trunk (FET) in Beijing Anzhen Hospital of Capital Medical University between January 2016 to December 2020 were enrolled in the present study. Patients were divided into higher D-dimer (>2307 ng/ml) group and lower D-dimer (≤2307 ng/ml) group. We compared the extent of dissection and branch artery perfusion patterns between the two groups. The restricted cubic spline (RCS) was performed to assess the association between D-dimer with the extent of dissection and major adverse events after surgery.

Results: Among 430 patients, there was 45(10.47%) in-hospital mortality and 156(36.28%) major adverse events. Patients with higher D-dimer had bigger dissection extension length and false lumen perimeter in ascending aorta, thoracic descending aorta, diaphragmatic, coeliac trunk, and renal artery level. For the branch artery perfusion patterns, Patients with higher D-dimer had a higher proportion of malperfusion among the innominate artery, right renal artery, and both side iliac artery, a higher proportion of dissected intercostal artery/all intercostal artery>0.5(43.46% vs 29.63%, p = 0.003). The RCS linear regression model revealed a nonlinear association between lnD-dimer with extension length and false lumen perimeter (all p for overall and p for nonlinearity＜0.001 except false lumen perimeter in ascending aorta level). The RCS logistic regression model revealed a linear association between lnD-dimer with major adverse events (p for overall＜0.001, p for nonlinearity = 0.637). The association between lnD-dimer and major adverse events was still significant in the fully adjusted logistic regression model with CTA characteristics (OR (95% CI) =1.388 (1.137, 1.695), p = 0.001).

Conclusions: Preoperative D-dimer strongly and positively correlates with the extent of dissection and major adverse events of ATAAD after total arch replacement (TAR) and frozen elephant trunk (FET). D-dimer seems to be a supplement that Indicates the severity of aortic dissection to aortic CTA.