Risk Factors for High Blood Product Use in Patients with Stanford Type A Dissection

Abstract

Background Intraoperative and postoperative bleeding associated with allogeneic blood transfusion and reoperation is still a common and feared complication in patients undergoing surgery due to acute Type A Aortic Dissection (aTAAD). The aim of our study was to identify risk factors for higher transfusion rates.

Methods In this retrospective single center study we evaluated pre -, intra-, and postoperative data of 121 patients with aTAAD. Depending on the median of received packed red blood cells (PRBCs), patients were divided into Group A (<8 PRBC, n = 53) and Group B (≥8 PRBC n = 68). Statistical analyses (descriptive statistics, univariable and multivariable logistic regression) were performed using SPSS software 25.0. Statistical significance was assumed at p-value <0.05.

Results A total of 120 patients received a blood product during their perioperative course. Among others we identified age, hemorrhagic pericardial effusion, and dual antiplatelet therapy as preoperative risk factors, low rectal temperature as intraoperative risk factor and low body temperature, positive fluid balance, high lactate level and beginning development of acute renal failure as postoperative risk factors.

Conclusion Our study identifies several factors which predict a higher likelihood of bleeding and consecutive blood transfusion. Knowledge of these factors could influence the therapy to reduce transfusion requirements and lead to a targeted and more efficient use of coagulation products.

Keywords

aortic disease - blood transfusion - aortic surgery - complications

Meeting Presentation

Annual Meeting of Deutsche Gesellschaft für Thorax-, Herz-und Gefäßchirurgie February 29 to March 03, 2020.

Publikationsverlauf

Eingereicht: 19. Mai 2021

Angenommen: 06. September 2021

Artikel online veröffentlicht:
18. Januar 2022

• References

• 1 Erbel R, Aboyans V, Boileau C. et al; ESC Committee for Practice Guidelines, The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J 2014; 35 (41) 2873-2926
• 2 Fine NL, Applebaum J, Elguezabal A, Castleman L. Multiple coagulation defects in association with dissecting aneurysm. Arch Intern Med 1967; 119 (05) 522-526
• 3 Chemtob RA, Moeller-Soerensen H, Holmvang L, Olsen PS, Ravn HB. Outcome after surgery for acute aortic dissection: influence of preoperative antiplatelet therapy on prognosis. J Cardiothorac Vasc Anesth 2017; 31 (02) 569-574
• 4 Xue Y, Chong H, Zhu X, Fan F, Wang D, Zhou Q. Aortic dissection patients mimic acute coronary syndrome with preoperative antiplatelet therapy. J Thorac Dis 2019; 11 (08) 3385-3390
• 5 Hansson EC, Dellborg M, Lepore V, Jeppsson A. Prevalence, indications and appropriateness of antiplatelet therapy in patients operated for acute aortic dissection: associations with bleeding complications and mortality. Heart 2013; 99 (02) 116-121
• 6 Hassan K, Bayer N, Schlingloff F. et al. Bleeding complications after use of novel oral anticoagulants in patients undergoing cardiac surgery. Ann Thorac Surg 2018; 105 (03) 702-708
• 7 Hansson EC, Geirsson A, Hjortdal V. et al. Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair. Eur J Cardiothorac Surg 2019; 56 (01) 182-188
• 8 Whitson BA, Huddleston SJ, Savik K, Shumway SJ. Risk of adverse outcomes associated with blood transfusion after cardiac surgery depends on the amount of transfusion. J Surg Res 2010; 158 (01) 20-27
• 9 Surgenor SD, Kramer RS, Olmstead EM. et al; Northern New England Cardiovascular Disease Study Group. The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg 2009; 108 (06) 1741-1746
• 10 Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 2002; 74 (04) 1180-1186
• 11 Banbury MK, Brizzio ME, Rajeswaran J, Lytle BW, Blackstone EH. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg 2006; 202 (01) 131-138
• 12 Galas FRBG, Almeida JP, Fukushima JT. et al. Blood transfusion in cardiac surgery is a risk factor for increased hospital length of stay in adult patients. J Cardiothorac Surg 2013; 8: 54
• 13 Moskowitz DM, McCullough JN, Shander A. et al. The impact of blood conservation on outcomes in cardiac surgery: is it safe and effective?. Ann Thorac Surg 2010; 90 (02) 451-458
• 14 Patil V, Shetmahajan M. Massive transfusion and massive transfusion protocol. Indian J Anaesth 2014; 58 (05) 590-595
• 15 Jennings LK, Watson S. Massive Transfusion. 2020. Treasure Island (FL): StatPearls Publishing; 2021
• 16 Meißner A, Schlenke P. Massive bleeding and massive transfusion. Transfus Med Hemother 2012; 39 (02) 73-84
• 17 Horvath KA, Acker MA, Chang H. et al. Blood transfusion and infection after cardiac surgery. Ann Thorac Surg 2013; 95 (06) 2194-2201
• 18 Chen FT, Chou AH, Wu VC. et al. Effect of massive blood transfusion on late outcomes after surgical repair of acute type A aortic dissection. Medicine (Baltimore) 2019; 98 (45) e17816
• 19 Karkouti K, O'Farrell R, Yau TM, Beattie WS. Reducing Bleeding in Cardiac Surgery Research Group. Prediction of massive blood transfusion in cardiac surgery. Can J Anaesth 2006; 53 (08) 781-794
• 20 Parr KG, Patel MA, Dekker R. et al. Multivariate predictors of blood product use in cardiac surgery. J Cardiothorac Vasc Anesth 2003; 17 (02) 176-181
• 21 Ferraris VA, Ferraris SP, Saha SP. et al; Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 2007; 83 (Suppl. 05) S27-S86
• 22 Trimarchi S, Eagle KA, Nienaber CA. et al; International Registry of Acute Aortic Dissection Investigators. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg 2010; 140 (04) 784-789
• 23 Zindovic I, Sjögren J, Bjursten H. et al. Predictors and impact of massive bleeding in acute type A aortic dissection. Interact Cardiovasc Thorac Surg 2017; 24 (04) 498-505
• 24 Martini WZ. Coagulopathy by hypothermia and acidosis: mechanisms of thrombin generation and fibrinogen availability. J Trauma 2009; 67 (01) 202-208 , discussion 208–209
• 25 Algarni KD, Yanagawa B, Rao V, Yau TM. Profound hypothermia compared with moderate hypothermia in repair of acute type A aortic dissection. J Thorac Cardiovasc Surg 2014; 148 (06) 2888-2894
• 26 Stamou SC, McHugh MA, Conway BD, Nores M. Role of moderate hypothermia and antegrade cerebral perfusion during repair of type A aortic dissection. Int J Angiol 2018; 27 (04) 190-195
• 27 Diab M, Platzer S, Guenther A. et al. Assessing efficacy of CytoSorb haemoadsorber for prevention of organ dysfunction in cardiac surgery patients with infective endocarditis: REMOVE-protocol for randomised controlled trial. BMJ Open 2020; 10 (03) e031912
• 28 Mehta Y, Mehta C, Kumar A. et al. Experience with hemoadsorption (CytoSorb^®) in the management of septic shock patients. World J Crit Care Med 2020; 9 (01) 1-12
• 29 Angheloiu AA, Angheloiu GO. Removal of dabigatran using sorbent hemadsorption. Int J Cardiol 2019; 293: 73-75
• 30 Hassan K, Kannmacher J, Wohlmuth P, Budde U, Schmoeckel M, Geidel S. Cytosorb adsorption during emergency cardiac operations in patients at high risk of bleeding. Ann Thorac Surg 2019; 108 (01) 45-51