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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
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Transfusion in Elective Proximal Aortic Reconstruction: Where Do We Currently Stand?
Stevan S Pupovac1, Jonathan M Hemli2, S Jacob Scheinerman2
1Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital/Northwell Health, Manhasset, New York.
Summary
Elective proximal aortic surgery can be performed with low transfusion rates. Valve-sparing root replacement (VSARR) and ascending aorta replacement require fewer blood products than composite root replacement, and intraoperative transfusion increases mortality risk.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Aortic Surgery Outcomes
Background:
- Aortic procedures carry high bleeding risks, but perioperative transfusion data are limited.
- Establishing transfusion benchmarks is crucial for assessing future standards in aortic surgery.
Purpose of the Study:
- To evaluate perioperative transfusion patterns in patients undergoing elective proximal aortic reconstruction.
- To identify factors influencing transfusion requirements and their impact on outcomes.
Main Methods:
- Retrospective analysis of 247 patients undergoing elective aortic reconstruction (June 2014-July 2017).
- Exclusion of patients with acute aortic syndrome, endocarditis, or prior cardiac surgery.
- Categorization of patients into three groups based on surgical procedure: ascending aorta replacement, composite valve-graft root replacement, and valve-sparing aortic root replacement (VSARR).
Main Results:
- Overall 30-day mortality was 2.02%.
- 30.4% of patients did not require any transfusion.
- Composite root replacement (group 2) was associated with a higher transfusion need compared to VSARR (group 3) and ascending aorta replacement (group 1).
- Intraoperative red blood cell (RBC) transfusion was independently linked to increased 30-day mortality.
Conclusions:
- Elective proximal aortic reconstruction can be achieved with modest blood product utilization.
- VSARR and isolated ascending aorta replacement are associated with lower transfusion requirements than composite root replacement.
- Minimizing intraoperative transfusions may improve survival outcomes in patients undergoing aortic surgery.
