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
