Blood conservation strategies reduce the need for transfusions in ascending and aortic arch surgery

Abstract

The aggressive use of a comprehensive blood conservation strategy in ascending and aortic arch surgery can significantly reduce the need for blood transfusions and is associated with less postoperative morbidity. Further evaluation with a randomized, controlled trial is warranted.

The Effect of Blood Transfusion on Outcomes in Aortic Surgery

“…Cambria et al 27 found that PRBC transfusion was one of the independent risk factors for mortality in patients undergoing thoracoabdominal surgery (OR, 1.4; 95% CI, 1.1-1.7; p ¼ 0.005). Chu et al, 6 in their evaluation of transfusion practices, found that the patients in the blood conservation group did indeed have less blood transfused, and had lower morbidity than the control group. However, a difference in mortality was not seen.…”

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“…Cambria et al 27 found that PRBC transfusion was one of the independent risk factors for mortality in patients undergoing thoracoabdominal surgery (OR, 1.4; 95% CI, 1.1-1.7; p ¼ 0.005). Chu et al, 6 in their evaluation of transfusion practices, found that the patients in the blood conservation group did indeed have less blood transfused, and had lower morbidity than the control group. However, a difference in mortality was not seen.…”

“…Complex aortic reconstruction, urgent presentations, multiple suture lines, prolonged CPB, and hypothermia account for the higher risk. 6 Unsurprisingly, there is a greater likelihood of exposure to blood products. 2,13 Nevertheless, most studies have excluded this group of patients from their analysis, and consequently, current transfusion guidelines are based on literature addressing nonaortic procedures.…”

“…This absence of consensus is even greater in aortic surgery, where research does not adequately address the issue of outcomes. [4][5][6] Transfusion policies are often extrapolated from studies examining other cardiac procedures (e.g., coronary artery bypass grafting [CABG], valve replacement). Here, we briefly summarize the benefits and risks of blood transfusion before reviewing current practices in cardiac surgery.…”

Unexpected Coagulation in the Bypass Pump Circuit

“…Hemodilution attenuates the adverse effects of hypothermia during cardiopulmonary bypass (CPB) on tissue perfusion [1]. While the priming volume of the bypass machine circuit provides hemodilution, acute normovolemic hemodilution is used to protect some portion of the patient's blood and to reduce need for packed blood products [2,3]. We present a case, where in our opinion; the whole blood collected from the patient caused premature coagulation in the bypass pump circuit.…”