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. 2022 Jul 20:12:20-29.
doi: 10.1016/j.xjon.2022.07.005. eCollection 2022 Dec.

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

Elizabeth L Norton  1 , Karen M Kim  2 , Shinichi Fukuhara  2 , Katelyn P Monaghan  2 , Aroma Naeem  2 , Xiaoting Wu  2 , Gorav Ailawadi  2 , Himanshu J Patel  2 , G Michael Deeb  2 , Bo Yang  2
Affiliations

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

Elizabeth L Norton et al. JTCVS Open. .

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.

Keywords: ABT, autologous blood transfusion; ATAAD, acute type A aortic dissection; CPB, cardiopulmonary bypass; FFP, fresh frozen plasma; INR, international normalized ratio; MPS, malperfusion syndrome; PRBCs, packed red blood cells; STS, Society of Thoracic Surgeons; acute type A aortic dissection; aorta; autologous blood transfusion; blood transfusion.

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Figures

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Graphical abstract
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Autologous blood transfusion improved short-term outcomes.
Figure 1
Figure 1
Patients with autologous blood transfusion had better postoperative outcomes, including sepsis, acute renal failure requiring dialysis, reintubation, and operative mortality.
Figure 2
Figure 2
Kaplan-Meier survival analysis of patients undergoing open acute type A aortic dissection repair with or without autologous blood transfusion (ABT) before (A) and after (B) propensity score match. The ABT group had significantly better midterm survival (5 year: 82% [95% CI, 77%-86%] vs 69% [95% CI, 57%-78%]; P = .009) in the whole cohort (A), but not in the propensity score-matched cohort (5 year: 76% [95% CI, 63%-85%] vs 74% [95% CI, 61%-84%]; P = .71) (B).
Figure 3
Figure 3
Autologous blood harvesting and transfusion was safe and improved short-term outcomes in patients undergoing open acute type A aortic dissection (ATAAD) repair. All patients undergoing open ATAAD repair could have autologous blood transfusion (ABT) unless they are unstable needing immediate cardiopulmonary bypass or severely anemic (hemoglobin <9 g/dL).
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