Blood transfusion in aortic root surgery impairs midterm survival

Area of Science:

• Cardiovascular Surgery
• Transfusion Medicine
• Surgical Outcomes Research

Background:

• Aortic root replacement is a complex procedure often necessitating perioperative transfusion.
• The impact of allogeneic packed red blood cell (RBC) transfusion on outcomes after aortic root replacement requires careful evaluation.

Purpose of the Study:

• To assess the effect of perioperative RBC transfusion on postoperative complications and survival following aortic root replacement.

Main Methods:

• A retrospective review of 760 patients undergoing aortic root replacement was conducted.
• Propensity score matching created 159 pairs of transfused and non-transfused patients to control for baseline differences.
• Outcomes including postoperative complications and survival were analyzed using Kaplan-Meier curves.

Main Results:

• RBC transfusion was associated with increased rates of prolonged ventilation, hemodialysis, and reoperation for mediastinal hemorrhage.
• Transfused patients experienced longer intensive care unit and hospital stays.
• While 30-day mortality was similar, 5-year survival was significantly reduced in the RBC-transfused group.

Conclusions:

• Perioperative RBC transfusion after aortic root replacement is linked to a higher incidence of postoperative complications.
• Despite similar preoperative and operative characteristics, RBC transfusion is associated with reduced midterm survival.
• These findings suggest a need to judiciously consider RBC transfusion in patients undergoing aortic root replacement.