Autologous Blood Transfusion in Acute Type A Aortic Dissection Decreased Blood Product Consumption and Improved Postoperative Outcomes
Elizabeth L. Norton1, Karen Kim2, Shinichi Fukuhara2, Aroma Naeem2, Xiaoting Wu2, Gorav Ailawadi2, Himanshu Patel2, G Michael Deeb2, Bo Yang2
1Creighton University School of Medicine, Omaha, Nebraska, United States, 2Department of Cardiac Surgery, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
Objective:To evaluate the effect of autologous blood usage on blood product consumption and short- and mid-term outcomes after acute type A aortic dissection (ATAAD) repair.
Methods:From 2010-October 2020, 497 patients underwent open ATAAD repair, including those with autologous blood transfusion (ABT, n=397) and without autologous blood transfusion (No-ABT, n=100). The median ABT volume was 900 mL. Using propensity score matching (PSM), 89 matched pairs were identified based on ten variables (age, sex, BMI, preoperative hemoglobin, coronary artery disease, any preoperative renal failure, acute preoperative stroke, previous cardiac surgery, cardiogenic shock, and severe aortic insufficiency).
Results:The ABT group was younger (59 vs 62 years, p=0.02), more male (70% vs 57%, p=0.02), and had higher BMIs (29 vs 27 kg/m2, p=0.04), and less cardiogenic shock (7% vs 24%, p<0.0001) than the No-ABT group. Preoperative hemoglobin (12 vs 13, p<0.0001) and hematocrit (35 vs 38, p=0.0003) were lower in the ABT group; however, platelets (173 vs 177, p=0.61) were similar between ABT and No-ABT groups. After PSM, both groups were similar. Both ABT and No-ABT groups underwent similar root and arch procedures except that the ABT group underwent more Zone 1 arch replacements (11% vs 3%, p=0.02). Cardiopulmonary bypass (217 vs 227 minutes, p=0.15), aortic cross-clamp, and hypothermic circulatory arrest times were similar between ABT and No-ABT groups. In both the whole and PSM cohorts, the ABT group required significantly less intraoperative and postoperative transfusion of blood products (4 vs 12 units, p<0.0001), including packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate with autologous blood transfusion being protective against intra- and post-operative blood product transfusion (OR=0.28; 95% CI: 0.11, 0.75; p=0.01). The ABT group had significantly less reoperation for bleeding, sepsis, stroke, acute renal failure requiring dialysis, reintubation, and shorter intubation times and postoperative lengths of stay in both the whole and PSM cohorts (Table). Operative mortality was three times less in the ABT group (5% vs 15%, p=0.0008) in the whole cohort, and two times less in the PSM cohort (6.7% vs 13%, p=0.14) with ABT having an OR of 0.50 (95% CI: 0.22, 1.16; p=0.11) for operative mortality by multivariable Logistic regression. The ABT group had significantly better mid-term survival (5-year: 82% vs 70%, p=0.008) in the whole cohort (Figure 1A), but not in the PSM cohort (5-year: 76% vs 74%, p=0.71, Figure 1B). ABT had a hazard ratio of 0.74 (95% CI: 0.44, 1.23) for mid-term mortality (p=0.24).
Conclusions: Autologous blood usage was associated with significantly less blood product consumption and better short-term outcomes; therefore, ABT should be used routinely for ATAAD repair.
Mid-term survival following acute type A aortic dissection repair amongst those receiving autologous blood transfusion and those without autologous blood transfusion in (A) the entire cohort and (B) the propensity matched cohort.
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