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Transfusion in Root Replacement for Aortic Dissection: The STS Adult Cardiac Surgery Database Analysis
Jonathan M Hemli1, Emma L Ducca2, William F Chaplin2
1Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York.
The Annals of Thoracic Surgery
|April 22, 2022
Summary
Blood transfusions are common in acute aortic dissection surgery, with over 90% of patients receiving them. Transfusion is linked to higher operative mortality and complications, emphasizing the need for careful management.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Aortic Disease
Background:
- Limited data exists on transfusion practices for acute aortic syndromes.
- Contemporary transfusion strategies for aortic dissection require further investigation.
Purpose of the Study:
- To describe current transfusion practices in patients undergoing aortic root replacement for acute Stanford type A aortic dissection.
- To identify factors associated with transfusion and postoperative morbidity in this patient population.
Main Methods:
- Utilized the Society of Thoracic Surgeons Adult Cardiac Surgery Database (July 2014-June 2017).
- Included 1558 patients who underwent primary aortic root replacement for acute type A aortic dissection.
- Employed multivariate regression to analyze transfusion predictors and outcomes.
Main Results:
- Transfusion was administered in 90.5% of cases.
- Intraoperative transfusion correlated with reduced short-term survival (OR 2.00, P=.025).
- Massive postoperative transfusion was linked to prolonged ventilation, sepsis, and renal failure.
Conclusions:
- The majority of patients with aortic dissection undergoing root replacement require blood products.
- Valve-sparing aortic root replacement is associated with lower transfusion rates compared to composite roots.
- Transfusion independently predicts increased operative mortality in acute aortic dissection.
