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

Objectives: Postoperative bleeding associated with allogeneic blood product transfusion and surgical reoperation are still common and feared complications in patients with acute aortic dissection (AAD). Aim of this study was to identify predictive factors causing higher blood loss and high transfusion rates.

Methods: This is a retrospective single-center study with evaluation of pre-, intra-, and postoperative data of 121 consecutive patients due to AAD Stanford type A. Depending on median of received blood products, patients were divided into group A (patients with < 8 packed red blood cells [PRBC]; n = 53) and group B (>8 PRBC; n = 68). Statistical analyses (descriptive statistics, bivariate logistic regression, multivariate logistic regression) were performed using SPSS software 25.0. Statistical significance was assumed at p < 0.05.

Results: Out of 121 patients (79 males/42 females; mean age of 64.9), 120 patients received any kind of blood product during the perioperative course. 11(9%) patients were redo surgeries. 63(52%) patients preoperatively received either DAPT (22%) or aspirin monotherapy (78%). 53(44%) patients showed hemodynamically relevant pericardial effusion. 22(18%) patients underwent rethoracotomy due to postoperative bleeding. In group A, a mean of 4.2 ± 1.83 PRBC, 4.6 ± 12.19 fresh frozen plasma (FFP), and 0.54 ± 0.50 platelet concentrate (PC) were transfused; in group B, a mean of 17.2 ± 12.99 PRBC, 15.2 ± 9.87 FFP, and 3.28 ± 2.64 PC were transfused. In bivariate and multivariate regression, preoperative predictive significant factors (p < 0.05) for increased need of transfusion were age, anticoagulation with aspirin or DAPT, and pericardial effusion. Preoperative hemoglobin or platelet level had no significant impact, as well as surgery duration or cross-clamp time. Intraoperative predictive factors were low rectal temperature, positive extracorporeal circulation (ECC) fluid balance, absence of retrograde autologous priming (RAP), and high lactate and vasopressor level. Postoperative significant factors were rethoracotomy, high drainage loss, positive fluid balance, low temperature, high lactate level, longer ventilation time, and sepsis.

Conclusion: Our study identifies several factors that could predict a higher likelihood of bleeding and consecutive transfusion in AAD patients. Knowledge of preoperative and intraoperative influencing factors could optimize the therapeutic regime reducing transfusion requirement. Therefore, transfusion products could be used faster and more efficient.

No conflict of interest has been declared by the author(s).