The following is a summary of the “Use of blood and blood products in aortic surgery is associated with adverse outcomes,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Sultan, et al.

To document the long-term effects of deep hypothermic circulatory arrest (DHCA) with and without the use of perioperative blood or blood products. Patients who had proximal aortic surgery using DHCA between 2011 and 2018 were matched on propensity scores based on demographic and clinical characteristics at baseline. Death rate was a primary metric along with other secondary measures of survival. A stratified Cox regression analysis was carried out to look for statistically significant correlations with survival.

Circulatory arrest was used in the aortic replacement procedures of 824 patients. The final matched patient count for each arm was 224 (transfusion and no transfusion). Standardized mean differences (SMDs) between groups were all below 0.1 for all baseline characteristics. Both the no transfusion and blood product transfusion groups had comparable preoperative hematocrit and ejection fraction (41.0 vs 40.6, SMD = 0.05) and ejection fraction (57.5% vs 57.0%, SMD = 0.08). There were no statistically significant differences in the rates of aortic dissection (42.9% vs 45.1%; SMD = 0.05), hemiarch replacement (70.1% vs 70.1%; SMD = 0.00), or total arch replacement (21.9% vs 23.2%; SMD = 0.03). 

Transfusion recipients had longer times for cardiopulmonary bypass and cross-clamping (P<.001). Transfusion cohort had significantly higher rates of mortality (9.4% vs 2.7%; P =.003), stroke (7.6% vs 1.3%; P =.001), reoperation rate, pneumonia, prolonged ventilation, and dialysis needs. Blood transfusions were found to be a significant risk factor for death in a multivariate Cox regression analysis (hazard ratio = 2.62 [95% CI = 1.47-4.67]; P =.001). The transfusion cohort had a significantly lower rate of 1 and 5-year survival (P< .001).

Aortic surgery patients who required perioperative transfusions had a higher risk of experiencing negative outcomes, even after adjusting for preoperative baseline characteristics.

Source: sciencedirect.com/science/article/abs/pii/S0022522321004529