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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

 

  • References

  • 1 Speiss BD. Transfusion and outcome in heart surgery. Ann Thorac Surg 2002; 74 (04) 986-987
    CrossrefPubMedGoogle Scholar
  • 2 Murphy GJ, Reeves BC, Rogers CA, Rizvi SI, Culliford L, Angelini GD. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007; 116 (22) 2544-2552
    CrossrefPubMedGoogle Scholar
  • 3 Leal-Noval SR, Rincón-Ferrari MD, García-Curiel A. et al. Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery. Chest 2001; 119 (05) 1461-1468
    CrossrefPubMedGoogle Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 Smith D, Grossi EA, Balsam LB. et al. The impact of a blood conservation program in complex aortic surgery. Aorta (Stamford) 2013; 1 (04) 219-226
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 McQuilten ZK, Andrianopoulos N, Wood EM. et al. Transfusion practice varies widely in cardiac surgery: results from a national registry. J Thorac Cardiovasc Surg 2014; 147 (05) 1684-1690.e1
    CrossrefPubMedGoogle Scholar
  • 7 Koch CG, Li L, Duncan AI. et al. Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg 2006; 81 (05) 1650-1657
    CrossrefPubMedGoogle Scholar
  • 8 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 (5, Suppl) S27-S86
    CrossrefPubMedGoogle Scholar
  • 9 Ferraris VA, Brown JR, Despotis GJ. et al; Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, International Consortium for Evidence Based Perfusion. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011; 91 (03) 944-982
    CrossrefPubMedGoogle Scholar
  • 10 Shore-Lesserson L, Baker RA, Ferraris VA. et al. The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, and the American Society of Extra Corporeal Technology: clinical practice guidelines—anticoagulation during cardiopulmonary bypass. Ann Thorac Surg 2018; 105 (02) 650-662
    CrossrefPubMedGoogle Scholar
  • 11 Pagano D, Milojevic M, Meesters MI. et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg 2018; 53 (01) 79-111
    CrossrefPubMedGoogle Scholar
  • 12 Velasquez CA, Singh M, Bin Mahmood SU. et al. The effect of blood transfusion on outcomes in aortic surgery. Int J Angiol 2017; 26 (03) 135-142
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    CrossrefPubMedGoogle Scholar
  • 14 Vamvakas EC, Taswell HF. Long-term survival after blood transfusion. Transfusion 1994; 34 (06) 471-477
    CrossrefPubMedGoogle Scholar
  • 15 Hébert PC, Wells G, Blajchman MA. et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340 (06) 409-417
    CrossrefPubMedGoogle Scholar
  • 16 Zacharias A, Habib RH. Factors predisposing to median sternotomy complications. Deep vs superficial infection. Chest 1996; 110 (05) 1173-1178
    CrossrefPubMedGoogle Scholar
  • 17 Leal-Noval SR, Marquez-Vácaro JA, García-Curiel A. et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med 2000; 28 (04) 935-940
    CrossrefPubMedGoogle Scholar
  • 18 Ranucci M, Pavesi M, Mazza E. et al. Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique. Perfusion 1994; 9 (05) 319-326
    CrossrefPubMedGoogle Scholar
  • 19 Michalopoulos A, Stavridis G, Geroulanos S. Severe sepsis in cardiac surgical patients. Eur J Surg 1998; 164 (03) 217-222
    CrossrefPubMedGoogle Scholar
  • 20 Corwin HL, Gettinger A, Pearl RG. et al. The CRIT study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med 2004; 32 (01) 39-52
    CrossrefPubMedGoogle Scholar
  • 21 Vincent JL, Baron JF, Reinhart K. et al; ABC (Anemia and Blood Transfusion in Critical Care) Investigators. Anemia and blood transfusion in critically ill patients. JAMA 2002; 288 (12) 1499-1507
    CrossrefPubMedGoogle Scholar
  • 22 Bracey AW, Radovancevic R, Riggs SA. et al. Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion 1999; 39 (10) 1070-1077
    CrossrefPubMedGoogle Scholar
  • 23 Stover EP, Siegel LC, Parks R. et al; Institutions of the Multicenter Study of Perioperative Ischemia Research Group. Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines: a 24-institution study. Anesthesiology 1998; 88 (02) 327-333
    CrossrefPubMedGoogle Scholar
  • 24 Chu MW, Losenno KL, Moore K, Berta D, Hewitt J, Ralley F. Blood conservation strategies reduce the need for transfusions in ascending and aortic arch surgery. Perfusion 2013; 28 (04) 315-321
    CrossrefPubMedGoogle Scholar
  • 25 Birla R, Nawaytou O, Shaw M. et al. Reducing blood transfusion in aortic surgery: a novel approach. Ann Thorac Surg 2019; 108 (05) 1369-1375
    CrossrefPubMedGoogle Scholar
  • 26 Fassl J, Matt P, Eckstein F. et al. Transfusion of allogeneic blood products in proximal aortic surgery with hypothermic circulatory arrest: effect of thromboelastometry-guided transfusion management. J Cardiothorac Vasc Anesth 2013; 27 (06) 1181-1188
    CrossrefPubMedGoogle Scholar
  • 27 Bavaria JE, Desai N, Szeto WY. et al. Valve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve: comparison with the 3-cusp David procedure. J Thorac Cardiovasc Surg 2015; 149 (2, Suppl) S22-S28
    CrossrefPubMedGoogle Scholar
  • 28 Cameron DE, Alejo DE, Patel ND. et al. Aortic root replacement in 372 Marfan patients: evolution of operative repair over 30 years. Ann Thorac Surg 2009; 87 (05) 1344-1349 , discussion 1349–1350
    CrossrefPubMedGoogle Scholar
  • 29 David TE, Feindel CM, David CM, Manlhiot C. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg 2014; 148 (03) 872-879 , discussion 879–880
    CrossrefPubMedGoogle Scholar
  • 30 Preventza O, Coselli JS, Garcia A. et al. Aortic root surgery with circulatory arrest: Predictors of prolonged postoperative hospital stay. J Thorac Cardiovasc Surg 2017; 153 (03) 511-518
    CrossrefPubMedGoogle Scholar