Research On The Predictive Value Of VWF For Perioperative Major Bleeding In Patients With Acute Type A Aortic Dissection

Objective:This study aims to investigate the expression and predictive value of von Willebrand Factor(vWF)levels in the perioperative period for predicting the risk of major bleeding in patients with acute type A aortic dissection.A multifactorial clinical prediction model based on vWF levels will be constructed to predict the risk of major bleeding in patients with acute type A aortic dissection.The predictive model will be evaluated and internally validated,providing a new theoretical basis for identifying and predicting the risk of major bleeding in patients with acute type A aortic dissection in clinical practice.Methods:This study collected data from 152 patients who underwent emergency surgery for acute type A aortic dissection at the Cardiovascular Center of our hospital from February 2021 to February 2023.Relevant information of patients was collected and analyzed,including the epidemiology of clinical symptoms,gender composition,age distribution,seasonality of disease onset,laboratory examination,etc.The patients were divided into two groups based on the presence or absence of major perioperative bleeding,and data analysis was performed using SPSS 25.0 software.The normality test was performed on the data,and metric variables that met the normal distribution were expressed as mean and standard deviation,and t-test was used for comparison between groups.The non-normal metric data between the two groups were analyzed using the rank sum test,and the median [quartile range] was used to represent the data.Count data were expressed as number(percentage),and the chi-square test or Fisher’s exact test was used for comparison between groups.Logistic regression was used for multivariate analysis,and P < 0.05 was considered statistically significant.The predictive value of vWF for perioperative major bleeding risk in patients with acute type A aortic dissection was analyzed using ROC curve.The risk prediction model for perioperative major bleeding in patients with acute type A aortic dissection was constructed using R software,and the model was evaluated and validated using consistency index(C-index),receiver operating characteristic curve(ROC),calibration plot,decision curve analysis(DCA),and clinical impact curve.Results:Among the 152 patients who underwent emergency surgery for acute type A aortic dissection at our hospital from February 2021 to February 2023,the male-to-female ratio was 3.2:1.107 patients(70.39%)had a history of hypertension.Nearly 135 patients(88.82%)presented with chest and back pain as their main complaint.The high incidence period for acute type A aortic dissection was from November to February,with a total of 92 cases,accounting for 60.5%.There were 28cases(18.4%)of major perioperative bleeding.Patients were divided into a major perioperative bleeding group and a non-major perioperative bleeding group for single-factor analysis,indicating that female sex,full arch replacement,non-Bentall root replacement,high preoperative von Willebrand factor(vWF)levels,onset-to-surgery time,extracorporeal circulation time,and D-dimer levels had statistically significant differences(P < 0.05).Using the above factors as independent variables,multiple-factor logistics regression analysis showed that female sex,full arch replacement,and high preoperative vWF levels(OR>1,P<0.05)were independent risk factors for major perioperative bleeding,while Bentall root replacement was not easily associated with major perioperative bleeding(OR<1,P<0.05).The risk prediction model for major perioperative bleeding in patients with acute type A aortic dissection was validated and showed high discrimination,good fit,and strong clinical usability.Conclusions : 1.The level of vWF increases with the increase of the risk of perioperative bleeding in patients with acute type A aortic dissection.Its level increase is an independent risk factor for perioperative bleeding in acute type A aortic dissection.2.The clinical prediction model for perioperative bleeding risk in patients with acute type A aortic dissection constructed by four factors,vWF,gender,whether the aortic arch is replaced with a total arch,and whether the aortic root is Bentall,has high discriminative ability,good fitting performance,and strong clinical utility.