To analyze the association between blood groups (ABO and Rh) and long-term outcomes following abdominal aortic aneurysm (AAA) repair.
Methods
Retrospective cohort study including all patients submitted to elective AAA surgery between 2009 and 2019. Outcomes were mortality and major adverse cardiac events (MACE).
Results
Of the 333 patients included in this study, 49.5% had blood type A, followed by 39.3% with type O, 8.1% with type B and 3.1% with type AB. Regarding Rh factor, 82.4% were Rh+ and 17.6% were Rh-. The distribution of the blood phenotypes was similar between AAA patients and the Portuguese population. The median follow-up time was 75.4 months (interquartile range 65.8–81.6). Patient survival rates at 1 and 5 years were 89.3% (95% Confidence Interval 86.0–92.7) and 61.9% (56.2–68.2), respectively. MACE-free survival at 1 and 5 years was 85.7% (81.9–89.5) and 57.6% (51.9–64.0), respectively. Survival and MACE-free survival rates were similar across blood group types. Age, maximum aortic diameter, peripheral arterial disease and chronic obstructive pulmonary disease were independent predictors of mortality. Maximum aortic diameter, estimated glomerular filtration rate, cerebrovascular disease and type of surgery were independent predictors of MACE.
Conclusion
We found no association between the blood types and the prevalence of AAA or adverse outcomes following AAA repair.
StatherPWSidloffDARhemaIA, et al.A review of current reporting of abdominal aortic aneurysm mortality and prevalence in the literature. Eur J Vasc Endovasc Surg2014; 47: 240–242.
2.
SvensjoSBjorckMGurtelschmidM, et al.Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease. Circulation2011; 124: 1118–1123.
3.
WanhainenAVerziniFVan HerzeeleI, et al.Editor's choice - European society for vascular surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg2019; 57: 8–93.
LarsonNBBellEJDeckerPA, et al.ABO blood group associations with markers of endothelial dysfunction in the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis2016; 251: 422–429.
6.
VasanSKRostgaardKMajeedA, et al.ABO blood group and risk of thromboembolic and arterial disease: a study of 1.5 million blood donors. Circulation2016; 133: 1449–1457.
7.
DentaliFSironiAPAgenoW, et al.Non-O blood type is the commonest genetic risk factor for VTE: results from a meta-analysis of the literature. Semin Thromb Hemost2012; 38: 535–548.
8.
ChenZYangSHXuH, et al.ABO blood group system and the coronary artery disease: an updated systematic review and meta-analysis. Sci Rep2016; 6: 23250.
9.
TakagiHUmemotoT. All-Literature Investigation of Cardiovascular Evidence ALICE Group. Meta-analysis of non-O blood group as an independent risk factor for coronary artery disease. Am J Cardiol2015; 116: 699–704.
10.
HeMWolpinBRexrodeK, et al.ABO blood group and risk of coronary heart disease in two prospective cohort studies. Arterioscler Thromb Vasc Biol2012; 32: 2314–2320.
11.
DentaliFSironiAPAgenoW, et al.ABO blood group and vascular disease: an update. Semin Thromb Hemost2014; 40: 49–59.
12.
WigginsKLSmithNLGlazerNL, et al.ABO genotype and risk of thrombotic events and hemorrhagic stroke. J Thromb Haemostasis2009; 7: 263–269.
13.
WuOBayoumiNVickersMA, et al.ABO(H) blood groups and vascular disease: a systematic review and meta-analysis. J Thromb Haemostasis2008; 6: 62–69.
14.
MasseliFVeseliAPfohlM, et al.Blood group AB is associated with reduced blood loss but also elevated cardiovascular mortality in aortocoronary bypass surgery. J Thromb Thrombolysis2024; 57: 512–519.
15.
WelsbyIJPhillips-ButeBMathewJP, et al.ABO blood group influences transfusion and survival after cardiac surgery. J Thromb Thrombolysis2014; 38: 402–408.
16.
PerssonMEdgrenGDalenM, et al.ABO blood type and risk of porcine bioprosthetic aortic valve degeneration: SWEDEHEART observational cohort study. BMJ Open2019; 9: e029109.
17.
TakagiH. ALICE All-Literature Investigation of Cardiovascular Evidence Group. Blood group and abdominal aortic aneurysm. Eur J Prev Cardiol2020; 27: 2195–2199.
18.
LeveyASStevensLASchmidCH, et al.A new equation to estimate glomerular filtration rate. Ann Intern Med2009; 150: 604–612.
19.
DuranJCTRodriguesFPestanaD. Distribution of blood groups in the Portuguese population. Adv Biosci (Oxford)2007; 29: 5–17.
20.
GünaydınZYYılmazE. The association between ABO blood groups and TASC II classification in patients with peripheral artery disease. Vascular2022; 31(3): 467–472.
21.
BoscoEHsuehLMcConeghyKW, et al.Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review. BMC Med Res Methodol2021; 21: 241.
22.
VlotAJKoppelmanSJBoumaBN, et al.Factor VIII and von Willebrand factor. Thromb Haemost1998; 79: 456–465.
23.
O'DonnellJLaffanMA. The relationship between ABO histo-blood group, factor VIII and von Willebrand factor. Transfus Med2001; 11: 343–351.
24.
OrstavikKHMagnusPReisnerH, et al.Factor VIII and factor IX in a twin population. Evidence for a major effect of ABO locus on factor VIII level. Am J Hum Genet1985; 37: 89–101.
25.
JenkinsPVO'DonnellJS. ABO blood group determines plasma von Willebrand factor levels: a biologic function after all?Transfusion2006; 46: 1836–1844.
26.
KosterTBlannADBrietE, et al.Role of clotting factor VIII in effect of von Willebrand factor on occurrence of deep-vein thrombosis. Lancet1995; 345: 152–155.
27.
RumleyALoweGDSweetnamPM, et al.Factor VIII, von Willebrand factor and the risk of major ischaemic heart disease in the Caerphilly Heart Study. Br J Haematol1999; 105: 110–116.
28.
NicholsWCGinsburgD. Von Willebrand disease. Medicine (Baltim)1997; 76: 1–20.
29.
MatsuiTShimoyamaTMatsumotoM, et al.ABO blood group antigens on human plasma von Willebrand factor after ABO-mismatched bone marrow transplantation. Blood1999; 94: 2895–2900.
30.
O'DonnellJMille-BakerBLaffanM. Human umbilical vein endothelial cells differ from other endothelial cells in failing to express ABO blood group antigens. J Vasc Res2000; 37: 540–547.
31.
ClarkPSattarNWalkerID, et al.The Glasgow Outcome, APCR and Lipid (GOAL) Pregnancy Study: significance of pregnancy associated activated protein C resistance. Thromb Haemost2001; 85: 30–35.
32.
ColoniaVJRoisenbergI. Investigation of associations between ABO blood groups and coagulation, fibrinolysis, total lipids, cholesterol, and triglycerides. Hum Genet1979; 48: 221–230.
33.
ArnaoutoglouEKouvelosGPapaN, et al.Platelet activation after endovascular repair of abdominal aortic aneurysm. Vascular2015; 24(3): 287–294.
34.
PolokKGórkaJFronczekJ, et al.Perioperative cardiovascular complications rate and activity of coagulation and fibrinolysis among patients undergoing vascular surgery for peripheral artery disease and abdominal aortic aneurysm. Vascular2020; 29(1): 134–142.
35.
OliverMFGeizerovaHCummingRA, et al.Serum-cholesterol and ABO and rhesus blood-groups. Lancet1969; 2: 605–606.
36.
ZindovicIEdgrenGNozohoorS, et al.ABO blood group and the risk of aortic disease: a nationwide cohort study. BMJ Open2020; 10: e036040.
AnvariMSBoroumandMAShoarS, et al.Ascending aorta aneurysm and blood group A among Iranian patients. Thromb Res2013; 131: e51–53.
39.
GuneHLarssonMNozohoorS, et al.Impact of ABO blood group on bleeding complications after surgery for acute type A aortic dissection. Blood Coagul Fibrinolysis2021; 32: 253–258.
40.
NozohoorSAhmadKBjurbomM, et al.ABO blood group does not impact incidence or outcomes of surgery for acute type A aortic dissection. Scand Cardiovasc J2020; 54: 124–129.
41.
HuangSChenYHuangZ, et al.Non-O blood group is associated with lower risk of in-hospital mortality in non-surgically managed patients with type A aortic dissection. BMC Cardiovasc Disord2020; 20: 515.
