Efficacy of Thromboelastography-Guided Blood Transfusion Management in Thoracic Aortic Surgery

In thoracic aortic surgery, a large amount of blood transfusion is required because of preoperative coagulopathy and long cardiopulmonary bypass (CPB) time. This study aimed to investigate the efficacy of intraoperative thromboelastography (TEG)-guided blood transfusion management in thoracic aortic surgery.

Between 2015 and 2017 at our institution, 53 patients who underwent elective thoracic aortic surgery with hypothermic circulatory arrest through median sternotomy were divided into 2 groups: group C, conventional management (25 patients); and group T, TEG-guided management (28 patients). In group T, TEG was measured twice, before and after CPB. In both groups, red blood cells (RBCs) were transfused to maintain hemoglobin levels >10 g/dL during surgery and >8 g/dL during CPB. Fresh frozen plasma (FFP) was transfused even during CPB to correct coagulant disorder before CPB was off. The ratio of RBC/FFP was 1:1 in group C and 1:2 in group T if pre-CPB citrated functional fibrinogen-maximum amplitude (CFF-MA) was ≤20 mm. Additional FFP was transfused if the value of post-CPB CFF-MA was ≤14 mm.

The amounts of postoperative bleeding, post-CPB RBC transfusion, postoperative RBC transfusion, and postoperative FFP transfusion were significantly lower in group T than in group C (P = .025, .042, .042, and .020, respectively). However, there was no impact on early and midterm survival of patients.

These results suggest that intraoperative TEG-guided blood transfusion management in thoracic aortic surgery is effective in reducing postoperative bleeding and the amount of blood transfusion.