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Eur J Cardiothorac Surg 2004;26:348-350
© 2004 Elsevier Science NL

Changes in coagulation condition, cytokine, adhesion molecule after repair of type A aortic dissection

Cardiovascular Surgery, National Hospital Kure Medical Center, Hiroshima, Japan

Received 16 January 2004; received in revised form 30 April 2004; accepted 3 May 2004.

^* Corresponding author. Address: Cardiovascular Surgery, Hayama Heart Center, 1898 Shimoyamaguchi, Hayama, Kanagawa 240-0116, Japan. Tel.: +81-46-875-1717; fax: +81-46-875-3636
e-mail: nomura{at}hayamaheart.gr.jp

Objective: Because residual dissection often exists even after the repair of a type A dissection, we evaluated coagulation conditions, cytokine levels, and adhesion molecule levels in mid-term follow up after repair of type A dissections. Methods: Thrombin–antithrombin III complex (TAT), D-dimer, soluble interleukin-2 receptor (sIL-2R), soluble intercellular adhesion molecule (sICAM)-1, and type III procollagen peptide (PIIIP) were measured in 12 patients (mean age=63 years) following the repair of a type A aortic dissection at 6–82 months after repair (median=33 months). Results: In the chronic phase, TAT and D-dimer were significantly higher in patients following the repair of a type A dissection compared to healthy controls (TAT; 12±8 vs. 2.5±1.2 ng/ml, P=0.0001, D-dimer; 779±1384 vs. 104±46 U/ml, P=0.0001). Cytokine was significantly higher in the affected patients (sIL-2R; 556±205 vs. 398±132 U/ml, P=0.003, sICAM-1; 255±131 vs. 211±48 ng/ml, P=0.136). Collagen turnover (PIIIP) showed a significantly higher value in the affected patients (0.80±0.32, vs. 0.58±0.13 U/ml, P=0.002). sIL-2R, sICAM-1 and PIIIP showed a negative correlation with the follow-up period (sIL-2R; r=–0.733,P=0.0067, sICAM-1; r=–0.61,P=0.035, PIIIP; r=–0.692,P=0.0126). We found a positive correlation between aortic size and TAT (r=0.644,P=0.0238,n=12) as well as with D-dimer (r=0.7831,P=0.0106,n=12) and TAT showed significantly higher values in the residual dissection group compared to those without residual dissection (16.6±7.9 vs. 7.45±4.75 ng/ml, P=0.035). Conclusion: Hypercoagulation conditions continued even after repair. Both TAT and D-dimer would be good indices for following up patients having repaired aortic dissections. Furthermore, cytokine, adhesion molecules, and collagen turnover would return to a stable state unless impairment and expansion of the vessel wall occurred.

Key Words: Coagulopathy • Aortic dissection • Cytokine • Adhesion molecule • Collagen turnover • Follow up

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