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Int J Angiol 2021; 30(04): 292-297
DOI: 10.1055/s-0041-1729860
Original Article

Transfusion in Elective Proximal Aortic Reconstruction: Where Do We Currently Stand?

Stevan S. Pupovac 
1   Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital/Northwell Health, Manhasset, New York
,
Jonathan M. Hemli
2   Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York
,
S Jacob Scheinerman
2   Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York
,
Alan R. Hartman
1   Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital/Northwell Health, Manhasset, New York
,
Derek R. Brinster
2   Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York
› Author Affiliations Funding The authors have no funding to disclose.
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Abstract

Aortic procedures are associated with higher risks of bleeding, yet data regarding perioperative transfusion in this patient population are lacking. We evaluated transfusion patterns in patients undergoing proximal aortic surgery to provide a benchmark against which future standards can be assessed.

Between June 2014 and July 2017, 247 patients underwent elective aortic reconstruction for aneurysm. Patients with acute aortic syndrome, endocarditis, and/or prior cardiac surgery were excluded. Transfusion data were analyzed by type of operation: ascending aorta replacement ± aortic valve procedure (group 1, n = 122, 49.4%); aortic root replacement with a composite valve–graft conduit ± ascending aorta replacement (group 2, n = 93, 37.7%); valve-sparing aortic root replacement (VSARR) ± ascending aorta replacement (group 3, n = 32, 13.0%).

Thirty-day mortality for the entire cohort was 2.02% (5 deaths). Overall, 75 patients (30.4%) did not require any transfusion of blood or other products. Patients in groups 1 and 3 were significantly more likely to avoid transfusion than those in group 2. Mean transfusion volume for any individual patient was modest; those who underwent VSARR (group 3) required less intraoperative red blood cells (RBC) than others. Intraoperative transfusion of RBC was independently associated with an increased risk of death at 30 days.

Elective proximal aortic reconstruction can be performed without the need for excessive utilization of blood products. Composite root replacement is associated with a greater need for transfusion than either VSARR or isolated replacement of the ascending aorta.

Keywords

ascending aortic dilation - cardiac surgery - aneurysm - aortic valve disease - cardiovascular disease - cardiovascular risk factors - dissection

Note

Presented at the Eastern Cardiothoracic Surgical Society (ECTSS) 55th Annual Meeting, Clearwater Beach, FL, United States, October 17–20, 2018.




Publication History

Article published online:
30 July 2021

© 2021. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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