Eastern Cardiothoracic Surgical Society

Transfusion in Elective Proximal Aortic Reconstruction: Where Do We Currently Stand?
Stevan S. Pupovac1, Jonathan Hemli2, S. J. Scheinerman2, Alan Hartman1, Derek Brinster1, 1North Shore University Hospital / Northwell Health, Manhasset, NY, USA, 2Lenox Hill Hospital / Northwell Health, New York, NY, USA

OBJECTIVE: Aortic procedures are associated with higher inherent risks of bleeding, yet data regarding perioperative transfusion requirements in this population is lacking. We evaluated transfusion patterns in patients undergoing proximal aortic surgery in order to provide a benchmark against which future quality metrics can be assessed.

METHODS: 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 from analysis. Transfusion data was analyzed by type of operation: Group 1, ascending aorta replacement aortic valve procedure (n=122, 49.39%); Group 2, ascending aorta + root replacement with a valve-graft conduit (n=93, 37.65%); Group 3, ascending aorta + valve-sparing root replacement (n=32, 12.96%). Circulatory arrest was utilized in all patients.

RESULTS: Total operative mortality was 2.02% (5 deaths). Overall, 72 patients (29.15%) did not require transfusion of blood or other products. Patients in Groups 1 (n=44, 36.07%) and 3 (n=10, 31.25%) were significantly more likely to avoid transfusion of blood and/or blood products than those in Group 2 (n=18, 19.35%) (p=0.0095, p=0.0005, respectively) (Figure 1). Group 2 patients received more clotting factors intraoperatively (n=23, 24.73%) than those in Groups 1 (n=9, 7.38%, p=0.0005) and 3 (n=2, 6.35%, p=0.023).

CONCLUSIONS: Root replacement with a valve-graft conduit is associated with greater need for transfusion than either valve-sparing root replacement or isolated replacement of the supra-coronary aorta.

Figure 1
Proportion of Patients Who Did Not Require
Transfusion of Blood and/or Other Blood Products
During Their Hospital Stay

Significant differences between groups indicated by brackets. RBC = red blood cells.
* other blood products: fresh frozen plasma, platelets and/or cryoprecipitate.