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CC BY 4.0 · Aorta (Stamford) 2017; 05(04): 106-116
DOI: 10.12945/j.aorta.2017.16.049
Original Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Too Cold to Clot? Does Intraoperative Hypothermia Contribute to Bleeding After Aortic Surgery?

Louis H. Stein
1   Division of Cardiothoracic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, USA
,
Gregory Rubinfeld
2   Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York, USA
,
Leora B. Balsam
2   Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York, USA
,
Patricia Ursomanno
3   Maimonides Heart and Vascular Center, Maimonides Medical Center, Brooklyn, New York, USA
,
Abe DeAnda Jr
4   Division of Cardiothoracic Surgery, University of Texas Medical Branch-Galveston, Galveston, Texas, USA
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Weitere Informationen

Publikationsverlauf

04. August 2016

12. März 2017

Publikationsdatum:
24. September 2018 (online)

   Lizenzen und Reprints

Abstract

Background: We determined the impact of intraoperative hypothermia on postoperative bleeding after thoracic aortic surgery.

Methods: We retrospectively analyzed 98 consecutive patients who underwent aortic surgery with deep hypothermic circulatory arrest between 2010 and 2014. We evaluated lowest temperature, absolute decrease in temperature, and rewarming rate. Univariate and multivariate regression were used to determine relationships between temperature, clinical characteristics, and measures of postoperative bleeding.

Results: The mean age of patients was 60.5 ± 15.1 years, with 64.3% male and 60% Caucasian. The lowest temperatures recorded were 13.5 ± 4.6°C at the bypass circuit. Change in hematocrit was associated with ethnicity, preoperative hematocrit, and rewarming rate. Chest tube output was associated with body mass index, preoperative platelet count, prior cardiac surgery, cardiopulmonary bypass (CPB) duration, intraoperative blood product transfusion, lowest surface temperature, and change in surface temperature. Postoperative packed red blood cell transfusion was associated with ejection fraction, chronic obstructive pulmonary disease (COPD), platelet count, partial thromboplastin time, CPB duration, and lowest blood temperature. Fresh frozen plasma transfusion correlated with COPD, CPB duration, and final blood temperature. Platelet transfusion correlated with body mass index and preoperative platelet count. Unplanned reoperation for bleeding was associated with final temperature and change in temperature.

Conclusion: We found no consistent associations between intraoperative temperature and indicators of bleeding. Intraoperative cooling strategies should be based on optimal end-organ protection rather than fear of postoperative bleeding; rewarming strategies may ameliorate the risk of coagulopathy.

Key Words

Aorta - Postoperative hemorrhage - Hypothermia
 

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