The Impact of a Blood Conservation Program in Complex Aortic Surgery

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Transfusion Medicine

Background:

• Recent guidelines support blood conservation in cardiac surgery.
• The application in complex aortic surgery remains less explored.

Purpose of the Study:

• To assess the feasibility and impact of blood conservation in complex aortic surgery.
• To evaluate clinical outcomes associated with these strategies.

Main Methods:

• A multidisciplinary approach was used for 63 complex aortic replacement procedures.
• Strategies included minimal crystalloid, small priming circuits, hemoconcentration, meticulous hemostasis, and tolerance of anemia (hemoglobin ≥ 7 mg/dL).

Main Results:

• 74% of patients avoided intraoperative packed red blood cell (pRBC) transfusion.
• Patients receiving ≤1 U of pRBCs had fewer complications (94%) compared to those receiving ≥2 U (59%).
• Low preoperative hematocrit and cardiopulmonary bypass time predicted pRBC transfusion.

Conclusions:

• Perioperative blood conservation is feasible in complex aortic surgery.
• This strategy is associated with better clinical outcomes and reduced complications.