Value of Thromboelastography as a Predictor of Postoperative Acute Respiratory Distress Syndrome in Patients With Acute Type A Aortic Dissection

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Background: This study aimed to evaluate the effectiveness of thromboelastography (TEG) in predicting postoperative acute respiratory distress syndrome (ARDS) in patients with acute type A aortic dissection (ATAAD). Methods: This retrospective cohort study included 350 consecutive patients with ATAAD who underwent emergency total aortic arch replacement surgery at our institution. Patients were divided into ARDS and non-ARDS groups based on the postoperative development of ARDS. Perioperative data were collected and compared between groups. Results: Overall, 56/350 (16.0%) patients developed postoperative ARDS, of whom four required reintubation and four progressed to respiratory failure. Although 30-day mortality was similar between the ARDS and non-ARDS groups (8.9% vs. 4.1%; p = 0.227), postoperative complications were more complex and severe in the ARDS group. Indeed, this group had longer ventilator use (p = 0.009), a higher incidence of severe pneumonia (p = 0.026), longer intensive care stays (p = 0.019), and more frequent respiratory failure (p = 0.096) and multiple organ failure (p = 0.040). Multivariate analysis identified preoperative clot angle (odds ratio (OR) 4.421, 95% confidence interval (CI) 1.922–8.743; p < 0.001), fibrinogen level (OR 4.473, 95% CI 2.678–9.399; p < 0.001), maximum amplitude (MA) (OR 4.552, 95% CI 2.089–8.947; p < 0.001), cardiopulmonary bypass time (OR 2.796, 95% CI 1.166–6.705; p = 0.021), and intraoperative plasma transfusion (OR 4.057, 95% CI 1.700–9.046; p = 0.004) as independent predictors of postoperative ARDS. The optimal cut-off values for preoperative fibrinogen level, clot angle, and platelet function (MA) on the receiver operating characteristic (ROC) curve analysis were 2.65 μg/mL, 59.4 degrees, and 64.1 mm, respectively, with corresponding areas under the curve of 0.744, 0.781, and 0.807 (all p < 0.001). Conclusion: Preoperative fibrinogen, clot angle, and MA may be useful predictors of postoperative ARDS in patients with ATAAD. TEG enables rapid preoperative assessment of coagulation system status, guiding fibrinogen supplementation and blood transfusion strategies to reduce the incidence of postoperative ARDS and shorten the duration of postoperative mechanical ventilation. Thus, TEG may be a valuable tool for real-time monitoring and improving postoperative outcomes in this population.

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