The Impact of Intraoperative Fibrinogen Replacement Therapy on the Clinical Outcome of Surgical Therapy for Type A Acute Aortic Dissection

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Abstract
Objectives: Fibrinogen replacement therapy (FRT) using fibrinogen concentrate (FC) may rapidly correct hypofibrinogenaemia; however, its clinical impact remains unclear, and this retrospective study aimed to evaluate the safety and efficacy of FC in surgically treated acute type A aortic dissection (ATAAD) patients. Methods: A retrospective study analysed 87 consecutive ATAAD patients who underwent emergency surgery. Patients were included in 2 groups: those who received FRT (Group F, n = 42) and those who did not (Group C, n = 45). Using a mixed model for repeated measures, we calculated the least squares (LS) mean differences between groups for intraoperative and postoperative fibrinogen levels and blood loss using the LS method. We also evaluated short-term surgical outcomes (postoperative complications) and long-term surgical outcomes (overall survival) for each group. Results: The change in fibrinogen levels during surgery did not differ significantly between groups. Postoperatively, however, the decrease in fibrinogen was smaller in the F group (LSMeans difference: −60.1; 95% confidence interval [CI]: −79.8, −40.4). Intraoperative blood loss was greater in the F group (LSMeans difference: −622 mL; 95% CI, −1037, −208), but no difference was observed in postoperative blood loss (LSMeans difference: −131 mL; 95% CI, −547, 286). Despite a higher proportion of severe cases in the F group, the difference in postoperative complication rates was approximately 10%. The difference in 1-month survival rate was 4.9%, and the difference in 1-year survival rate was 19.5%. Conclusions: In the surgical treatment of ATAAD, FRT increases fibrinogen levels by approximately 71 mg/dL, achieving adequate haemostasis without increasing adverse outcomes. Additionally, FC is effective in reducing postoperative blood loss in patients with a bleeding tendency whose fibrinogen level is below 150 mg/dL before weaning from cardiopulmonary bypass.

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