Autologous blood transfusion in acute type A aortic dissection decreased blood product consumption and improved postoperative outcomes

• Authors: Elizabeth L Norton, Emory University; Karen M Kim, Michigan Medicine; Shinichi Fukuhara, Michigan Medicine; Katelyn P Monaghan, Michigan Medicine; Aroma Naeem, Michigan Medicine; Xiaoting Wu, Michigan Medicine; Gorav Ailawadi, Michigan Medicine; Himanshu J Patel, Michigan Medicine; Michael G Deeb, Michigan Medicine; Bo Yang, Michigan Medicine
• Journal Title: JTCVS Open
• Volume: Volume 12
• Publisher: Elsevier | 2022-12-01, Pages 20-29
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.xjon.2022.07.005
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: blood transfusion

Abstract

Objective: To evaluate the effect of autologous blood use on blood product consumption and outcomes after acute type A aortic dissection repair. Methods: From 2010 to October 2020, 497 patients underwent open acute type A aortic dissection repair, including those with autologous blood harvesting before cardiopulmonary bypass and transfusion after cardiopulmonary bypass (autologous blood transfusion [ABT], n = 397) and without autologous blood harvesting and transfusion (No-ABT, n = 100). The median ABT volume was 900 mL. Using propensity score matching, 89 matched pairs were identified based on age, sex, body mass index, preoperative hemoglobin, acute preoperative stroke, previous cardiac surgery, and cardiogenic shock. Results: After propensity score matching, both groups were similar in demographic characteristics and aortic procedures. The ABT group required significantly less intraoperative transfusion of blood products (6 vs 11 units; P < .0001), including packed red blood cells (2 vs 4), fresh frozen plasma (2 vs 4), platelets (2 vs 2), and cryoprecipitate (0 vs 1); and combined intraoperative and postoperative transfusion (9 vs 13; P < .001). ABT was protective against intra- and postoperative blood product transfusion (odds ratio, 0.28; P = .01). The ABT group had significantly less sepsis, acute renal failure requiring dialysis, reintubation, and shorter intubation times and postoperative lengths of stay. Operative mortality was 6.7% in the ABT group versus 13% in the No-ABT group (P = .14). The midterm survival was similar between the 2 groups (5 year: 76% vs 74%). ABT had a hazard ratio of 0.81 for midterm mortality (P = .41). Conclusions: Autologous blood transfusion was associated with better short-term outcomes and could be used routinely for acute type A aortic dissection repair. External multicenter prospective validation would be warranted.