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Abstract

Introduction

Patients undergoing total aortic arch replacement (TAAR) usually require blood products perioperatively. This cohort study aimed to investigate the impact of a comprehensive blood conservation program on the major complications in these patients.

Methods

Patients with traditional or comprehensive blood management intraoperatively from January 2017 to December 2018 were included. We compared the rates of major complications (cerebral vascular accident, acute kidney injury, or mortality) between the two groups after propensity score matching (PSM). The association between blood management and outcomes was assessed by logistic regression. Restricted cubic splines (RCS) were built to evaluate the impact of fresh frozen plasma (FFP) on complications. Patients were stratified by the ratio of FFP/RBC (red blood cell) to investigate the effect of the ratio on complications.

Results

After 1:1 PSM, 200 patients were selected. 35% (35/100) of patients suffered major complications in the traditional group, while it decreased to 22% (22/100) in the comprehensive management group (OR = 0.524, p = 0.043). Multivariable logistic regression showed that FFP was a risk factor (OR = 1.186, p = 0.014). RCS results indicated that with the increase of FFP, the risk of complications gradually increases. The cut-off value was 402 mL. Patients in the group of ratio = 0 ∼ 0.5 had a higher chance than those without transfusion (OR = 7.487, p < 0.001).

Conclusions

Comprehensive blood conservation program in patients undergoing TAAR is safe and can reduce the incidence of major complications, which are associated with FFP volume and the ratio of FFP/RBC.

Keywords

total aortic arch replacement blood conservation fresh frozen plasma restricted cubic spline the ratio of fresh frozen plasma/red blood cell

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References

Wang

, et al. Intraoperative platelet transfusion is associated with increased postoperative sternal wound infections among type A aortic dissection patients after total arch replacement. Transfus Medicine (Oxford, England) 2014; 24: 400–405.

Liu

, et al. Blood transfusion and acute kidney injury after total aortic arch replacement for acute stanford type A aortic dissection. Heart Lung Circulation 2022; 31: 136–143.

Xie

Zhong

, et al. Blood transfusion predicts prolonged mechanical ventilation in acute stanford type A aortic dissection undergoing total aortic arch replacement. Front Cardiovascular Medicine 2022; 9: 832396.

Pagano

Milojevic

Meesters

, et al. 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. Eur Journal Cardio-Thoracic Surgery: Official Journal Eur Assoc Cardio-Thoracic Surg 2018; 53: 79–111.

Zhang

Zhao

Gao

, et al. Quality management of a comprehensive blood conservation program during cardiopulmonary bypass. Ann Thoracic Surgery 2022; 114: 142–150.

Chen

Chou

, et al. Effect of massive blood transfusion on late outcomes after surgical repair of acute type A aortic dissection. Medicine 2019; 98: e17816.

Al-Khabori

Al-Riyami

Baskaran

, et al. Discriminatory power of the intraoperative cell salvage use in the prediction of platelet and plasma transfusion in patients undergoing cardiac surgery. Transfus Apheresis Science: Official Journal World Apher Assoc: Official Journal Eur Soc Haemapheresis 2015; 53: 208–212.

Wang

Bainbridge

Martin

, et al. The efficacy of an intraoperative cell saver during cardiac surgery: a meta-analysis of randomized trials. Anesth Analgesia 2009; 109: 320–330.

Lei

Chen

Jin

, et al. Preoperative and intraoperative risk factors for prolonged intensive care unit stay after aortic arch surgery. J Cardiothoracic Vascular Anesthesia 2009; 23: 789–794.

10.

Jiang

, et al. Perioperative results and risk factors for in-hospital mortality in patients with stanford type A aortic dissection undergoing sun's procedure - a single center study. Heart Surgery Forum 2018; 21: E432–e437.

11.

Mazzeffi

Chriss

Davis

, et al. Optimal plasma transfusion in patients undergoing cardiac operations with massive transfusion. Ann Thoracic Surgery 2017; 104: 153–160.

12.

Delaney

Stark

Suh

, et al. Massive transfusion in cardiac surgery: the impact of blood component ratios on clinical outcomes and survival. Anesth Analgesia 2017; 124: 1777–1782.

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The impact of comprehensive blood conservation program on major complications after total aortic arch replacement